Customer
Survey
1)
Would you be interested in buying this product or service?  Yes No
Note the
following about the person you are interviewing:
Gender: Male Female
Age: 4-10 10-18 19-25 25-35 35-50 50-65 65-75 Over 75
In what part of town do you live?
Family Status: Single Couple (no kids) Couple (kids at
home)
Couple (grown kids)
Notes:
2)
How far would you travel to purchase my product or service?
1-5
miles 6-10
miles 11-15
miles more
than 15 miles
Would by on-line Would order by
telephone Other
Response
Notes:
3)
How often would you purchase my product or service?
Only
onceWeekly Monthly Every 3 months
Every 6 months Other Response
Notes:
4)
When would you be most likely to purchase from me?
Day(s) of Week:
Month of year:
Time of day:
Other response:
4)
Are you interested in this product for
Yourself
Your home
Your business
Your child
Other family member
As a gift
Other
5)
Why would you buy this product or service?
To print this survey:
Select File and then Print from your browser's menu.
Click
here to return to the Research Page.
Click
here to return home.
|
