Number of Questions: 20
Payment for Completing Survey: $20 USD
(this is not a working survey, just a sample)
1. Please supply us with your contact
information:
Name:
Organisation:
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
Thank you for taking the time to complete
this survey. Select Submit Survey now to send your responses to us.