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2012
July
J
jjoshi
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1. Hello:
You are invited to participate in our survey [Project Description Here]. In this survey, approximately [Approximate Respondents] people will be asked to complete a survey that asks questions about [General Survey Process]. It will take approximately [Approximate Time] minutes to complete the questionnaire.
Your participation in this study is completely voluntary. There are no foreseeable risks associated with this project. However, if you feel uncomfortable answering any questions, you can withdraw from the survey at any point. It is very important for us to learn your opinions.
Your survey responses will be strictly confidential and data from this research will be reported only in the aggregate. Your information will be coded and will remain confidential. If you have questions at any time about the survey or the procedures, you may contact [Name of Survey Researcher] at [Phone Number] or by email at the email address specified below.
Thank you very much for your time and support. Please start with the survey now by clicking on the
Continue
button below.
I Agree
2. How often do you conduct surveys?
Weekly
Monthly
Quarterly
Annually
3. What types of credit cards do you have (Select all that apply)?
Visa
Mastercard
American Express
Discover
Diners Club
4. How satisfied are you with the following:
Very Unsatisfied
Unsatisfied
Neutral
Satisfied
Very Satisfied
Website
Customer Service
Overall
5. How long have you been at your current residence?
6. Descriptive/Spacer Text Here
7. Please rank (1-3) the following in order of interest:
Skiing
-- Select --
1
2
3
Snowboarding
-- Select --
1
2
3
Biking
-- Select --
1
2
3
8. Please allocate 100 points on how you spend your income:
Essentials (Gas, Grocery etc.)
Entertainment (Movies, Clubs etc.)
Other
0
9. What is your date of birth?
--
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
--
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
--
2024
10. Contact Information
*
First Name
:
*
Last Name
:
*
Email Address
:
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