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How often do you conduct surveys? (Single Select)
 
Weekly
 
Monthly
 
Quarterly
 
Annually
 
 
 
What types of credit cards do you have (Select many)?
 
Visa
 
Mastercard
 
American Express
 
Discover
 
Diners Club

 
 
 
How often do you conduct surveys? (Drop Down)
 
 
 
Comments Box:
   
 
 
 
Name ${piping_text}
   
 
 
 
How long have you been at your current residence? (Numeric Input)
   
 
 
 
Email Address
   
 
 
How satisfied are you with the following: (Multi-Point Scales)
Very Unsatisfied Unsatisfied Neutral Satisfied Very Satisfied
Website
Customer Service
Overall
 
 
How satisfied are you with the following: (Checkbox-Multi-Select)
Very Unsatisfied Unsatisfied Neutral Satisfied Very Satisfied
Website
Customer Service
Overall
 
 
How satisfied are you with the following: (Spreadsheet)
Very Unsatisfied Unsatisfied Neutral Satisfied Very Satisfied
Website
Customer Service
Overall
 
 
 
Please rank (1-3) the following in order of interest:
Skiing
Snowboarding
Biking
 
 
 
Please drag and rank(1st to 3rd) the following in order of interest:
Drag your choices here to rank them
     
     
     
    Please allocate 100 points on how you spend your income:
    Essentials (Gas, Grocery etc.)
    Entertainment (Movies, Clubs etc.)
    Other
    0
     
     
     
    How satisfied are you with our services?
    Very Unsatisfied
    Unsatisfied
    Neutral
    Satisfied
    Very Satisfied
     
     
    Please rate the following:
    Books
    Movies
    Music
     
     
     
    Presentation Text
     
     
     
    Section Heading
     
     
     
    Section Sub-Heading
     
     
     
    Date and Time Question
     
     
    Contact Info Question
    First Name : 
    Last Name : 
    Address 1 : 
    Address 2 : 
    City : 
    State : 
    Zip : 
    Phone : 
    Email Address : 
     
     
     
    ImportanceSatisfaction
    Not ImportantVery Important
    Not SatisfiedVery Satisfied
    1234512345
    Customer Service
    Product Packaging
    On-Time Arrival
     
     
    How satisfied are you with the following: (Slider Scale)
    Website
    -
    Customer Service
    -
    Overall
    -
     
     
    How satisfied are you with the following: (Slider Categorial text)
    Very Unsatisfied Unsatisfied Neutral Satisfied Very Satisfied
    Website
    -
    Customer Service
    -
    Overall
    -
     
     
     
    Which is your favorite care?
    Jaguar
    Aston Martin
     
     
     
    What types of credit cards do you have (Select all that apply)?
    Aston Martin
    Jaguar
    Lamborgini