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How long have you been a customer?
 
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
 
 
 
What products/services of ours do you use?
 
{PRODUCT/SERVICE 1}
 
{PRODUCT/SERVICE 2}
 
{PRODUCT/SERVICE 3}
 
{PRODUCT/SERVICE 4}
 
{PRODUCT/SERVICE 5}
 
Other
 

 
 
How frequently do you purchase our products/services?
Don't purchase Once a year or less Every 7-12 months Every 2-6 months Once a month Every 2-3 weeks Once or more a week
{PRODUCT/SERVICE 1}
{PRODUCT/SERVICE 2}
{PRODUCT/SERVICE 3}
{PRODUCT/SERVICE 4}
{PRODUCT/SERVICE 5}
 
 
How important were each of the following attributes in your decision to purchase our product/service?
Not important Somewhat important Neutral Somewhat important Very important
Pricing
Ease of use
Quality of products/services
Responsiveness of support staff
Store location
 
 
 
Do you purchase mainly in the physical retail store or online?
 
Physical retail store
 
Online store
 
Purchase from both equally
 
 
 
Which city do you live in?
 
{CITY YOU SERVICE 1}
 
{CITY YOU SERVICE 2}
 
{CITY YOU SERVICE 3}
 
Other
 
 
 
 
Please indicate your gender.
 
Male
 
Female
 
Prefer not to answer
 
 
 
Which range includes your age?
 
Younger than 18
 
18 - 24
 
25- -34
 
35 - 44
 
45 - 54
 
55 - 64
 
65 or older
 
Prefer not to answer
 
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