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Surveys
2012
February
R
Research Report
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Rank the following colours:
Blue
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1
2
3
4
Green
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1
2
3
4
Yellow
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1
2
3
4
Red
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1
2
3
4
Which job do you have?
Doctor
Lawyer
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Other
What types of credit cards do you have (Select all that apply)?
Visa
Mastercard
American Express
Discover
Diners Club
How often do you conduct surveys?
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Weekly
Monthly
Quarterly
Annually
Comments/Suggestions:
What is your date of birth?
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01
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Jan
Feb
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Jun
Jul
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2024
Contact Information
First Name
:
Last Name
:
Address 1
:
Address 2
:
City
:
State
:
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
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Maine
Maryland
Massachusetts
Michigan
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Montana
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Ohio
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Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
District of Columbia
Zip
:
Phone
:
Email Address
:
How satisfied are you with the following:
Very Unsatisfied
Unsatisfied
Neutral
Satisfied
Very Satisfied
Website
Customer Service
Overall
How satisfied are you with the following:
Very Unsatisfied
Unsatisfied
Neutral
Satisfied
Very Satisfied
Website
Customer Service
Overall
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