Survey Topic: Sample One
Number of Questions: 20
Payment for Completing Survey: USD$20
1. Please supply us with your contact
information:
Name:
Organization:
Address:
City and State:
ZIP Code:
E-mail:
2. Do you currently use any "PRODUCT"?
Yes
No
Don't know
3. What brand of "PRODUCT" are you
currently using?
Brand 1
Brand 2
Brand 3
Brand 4
Brand 5
Other
4. How did you purchase this "PRODUCT"?
Retail Store
Direct Mail
Catalog
Web
Company
Other
5. Are there features that this product
does not have that you would want out of a "PRODUCT"?
Yes
No
Don't know
6. What features does your "PRODUCT"
not have that you wish it did?
7. How much did you pay for your "PRODUCT"?
8. How satisfied are you with your
"PRODUCT"?
Very Satisfied
Somewhat Satisfied
Somewhat Dissatisfied
Very Dissatisfied
9. Of the following list of features,
please select the top three that would be of interest to you:
Feature 1
Feature 2
Feature 3
Feature 4
Feature 5
Feature 6
10. Of the three features you just
listed, please rank them first, second and third in importance
to you:
1.
2.
3.
11. Are there any additional features
that would be of importance to you?
Additional Feature 1
Additional Feature 2
Additional Feature 3
Additional Feature 4
Additional Feature 5
12. Are there particular features
that a product must have for you to purchase it? Please list
what they are in order of importance:
Essential Feature 1
Essential Feature 2
Essential Feature 3
Essential Feature 4
Essential Feature 5
13. How much would you be willing
to pay for a product with these features ("LIST FEATURES")?
14. If the "PRODUCT" was priced at
(price) how likely, on a percentage basis, would you be to buy
it? (0% = Not at all likely to buy, 100% = Completely likely
to buy)
15. How much are you authorized to
spend on new products?
16. What do you think about the price
of this "PRODUCT"?
Extremely Low
Somewhat Low
Just right
Somewhat High
Extremely High
17. Through what means would you be
least likely to purchase this "PRODUCT"?
Retail
Direct Mail
Mail Order Catalog
Classified Advertisement
Telemarketer
18. Through what means would you be
least likely to purchase this "PRODUCT"?
Retail
Direct Mail
Mail Order Catalog
Classified Advertisement
Telemarketer
19. What do you think would be a good
name for such a "PRODUCT"?
20. Can you please tell us which one
of the following possible product names you like the most?
Product 1
Product 2
Product 3
Product 4
Product 5
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