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| What is your date of birth? |
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| Month | Day | Year | | | | |
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| Please rank (1-3) the following in order of interest: |
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| | Reading Listening Music Biking
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| What do you think of concept of a Mobile? |
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| Are you planning to buy a Mobile |
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| Are you planning to buy Headphones? |
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| Would you like Headphone/Mobile Offer? |
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| Please rank (1-3) the following in order of interest: |
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| Reading |
| | | Listening Music |
| | | Biking |
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| How satisfied are you with the following:
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| Considering your complete experience with our company, how likely would you be to recommend our products to a friend or colleague? |
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| Please select the city you live in. |
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| How would you rate Mobile/Headphone on following features?
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| Ratings | Satisfaction | | | | | | Product Packaging | | | | On-Time Arrival | | | | Price | | |
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| Please drag/ crop the area of your interest on the image: |
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| When are you planning to buy a Mobile |
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| What types of credit cards do you have (Select all that apply)? |
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| How satisfied are you with the following:
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