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  5. Blake's Banking Software
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Contact Information
First Name : 
Last Name : 
Phone : 
Email Address : 
 
 
 
How interested would you be in purchasing {PRODUCT NAME & DESCRIPTION}?
 
Very interested
 
Interested
 
Neutral
 
Uninterested
 
Very uninterested
 
 
Would the following attributes make you more or less interested in purchasing {PRODUCT NAME}?
Much Less Interested Somewhat Less Interested Neutral Somewhat More Interested Much More Interested
{ATTRIBUTE 1}
{ATTRIBUTE 2}
{ATTRIBUTE 3}
{ATTRIBUTE 4}
{ATTRIBUTE 5}
 
 
 
If this product were available today, when would you be most likely to buy it?
 
Within the next month
 
Between 1 and 3 months from now
 
Between 4 and 6 months from now
 
Between 7 months and a year from now
 
I am not interested
 
 
Please indicate the degree to which you agree/disagree with the following statements about the similar product you currently use.
Strongly Disagree Somewhat Disagree Neutral Somewhat Agree Strongly Agree
Sufficient for my needs
Meets my expectations
Reasonably priced
 
 
 
What do you currently use as an alternative to our proposed product?
 
{ALTERNATIVE 1}
 
{ALTERNATIVE 2}
 
{ALTERNATIVE 3}
 
{ALTERNATIVE 4}
 
{ALTERNATIVE 5}
 
I do not use a similar product
 
Other
 
 
 
 
Please provide additional comments about your current product.
   
 
 
 
Which payment method do you prefer?
 
Cash
 
Check
 
Credit card
 
Debit card
 
Payment plan
 
 
 
Please provide any additional comments about our proposed product.