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Questions marked with an * are required Exit Survey
 
How satisfied are you with the following:
LeftRight
Very Unsatisfied Unsatisfied Neutral Satisfied Very Satisfied N/A
Website
Customer Service
Overall
 
 
 
What types of credit cards do you have (Select all that apply)?
 
Visa
 
Mastercard
 
American Express
 
Discover
 
Diners Club
 
Other
 

 
 
 
* What is your gender?
 
Male
 
Female
 
 
 
What is your marital status?
 
Single (Never married)
 
Married
 
Domestic partnership
 
Widowed
 
Divorced
 
Separated
 
Don’t know
 
 
 
What is your favorite hobby or interest?
 
Auto racing
 
Biking
 
Boating
 
Bowling
 
Camping
 
Crafts
 
Dancing
 
Fine Arts
 
Fishing
 
Gambling
 
Gardening
 
Hiking
 
Hunting
 
Horseback riding
 
Kayaking
 
Martial Arts
 
Music
 
Photography
 
Reading
 
Sports
 
Travel
 
Other
 
 
 
How long have you used our products?
 
Less than 6 months
 
6 months to less than 1 year
 
1 year to less than 3 years
 
3 years to less than 5 years
 
5 years or more
 
 
 
How likely are you to continue doing business with us?
 
Very likely
 
Somewhat likely
 
Neutral
 
Somewhat unlikely
 
Very unlikely
 
 
 
* First Name : 
* Last Name : 
* Address 1 : 
   Address 2 : 
* City : 
* State : 
* Zip : 
Phone : 
Email Address :