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How long have you been purchasing 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 often do you use the following products?
Don't Use Daily Weekly Monthly Quarterly
{PRODUCT 1}
{PRODUCT 2}
{PRODUCT 3}
{PRODUCT 4}
{PRODUCT 5}
 
 
Comment:
   
 
 
 
Where do you purchase our products? Select all that apply.
 
In our store
 
Online
 
Telephone order/catalogue
 
Through a dealer
 
Through an agent
 
Through a wholesaler
 
Other
 

 
 
 
How would you rate your overall level of satisfaction with us?
 
Highly satisfied
 
Somewhat satisfied
 
Neutral
 
Somewhat dissatisfied
 
Highly dissatisfied
 
 
Comment:
   
 
 
How do we rate on the following attributes?
Well Below Average Below Average Average Above Average Well Above Average
Customer service experience
Professionalism
Purchase experience
Quality of products
Understanding customers' needs
 
 
Comment:
   
 
 
 
How likely are you to continue using our products?
 
Very likely
 
Somewhat likely
 
Neutral
 
Somewhat unlikely
 
Very unlikely
 
 
 
Have you ever recommended us to others?
 
No, never recommended
 
Have recommended once or twice
 
Have recommended several times
 
 
 
How do we rate in comparison to other companies that offer the same products?
 
Much higher
 
Somewhat higher
 
Same
 
Somewhat lower
 
Much lower
 
Don't know
 
 
 
Do you have any suggestions for improvement?
   
 
 
 
What is your gender?
 
Male
 
Female
 
Prefer not to answer
 
 
 
Which of the following categories describes your age?
 
Younger than 18
 
18 - 24
 
25 - 34
 
35 - 44
 
45 - 54
 
55 - 64
 
65 or older
 
Prefer not to answer
 
 
 
What best describes your employment status?
 
Employed full-time
 
Employed part-time
 
Self-employed
 
Unemployed, looking for work
 
Unemployed, not looking for work
 
Student
 
Retired
 
Military
 
Homemaker
 
Prefer not to answer
 
Other
 
 
 
 
Which category best describes your annual income?
 
Under $15,000
 
$15,000 - $29,999
 
$30,000 - $44,999
 
$45,000 - $59,999
 
$60,000 - $74,999
 
$75,000 - $89,999
 
$90,000 or more
 
Prefer not to answer
 
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