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  2. 2005
  3. June
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Hello:

You are invited to participate in our survey [Project Description Here]. In this survey, approximately [Approximate Respondents] people will be asked to complete a survey that asks questions about [General Survey Process]. It will take approximately [Approximate Time] minutes to complete the questionnaire.


Your participation in this study is completely voluntary. There are no foreseeable risks associated with this project. However, if you feel uncomfortable answering any questions, you can withdraw from the survey at any point. It is very important for us to learn your opinions.


Your survey responses will be stricly confidential and data from this research will be reported only in the aggregate. Your information will be coded and will remain confidential. If you have questions at any time about the survey or the procedures, you may contact [Name of Survey Researcher] at [Phone Number] or by email at the email address specified below.


Thank you very much for your time and support. Please start with the survey now by clicking on the Continue button below.
 
 
 
Additional Comments/Suggestions for improvement
   
 
 
Please rate the following characteristics of the service representative on a scale from 1 to 5, where 1 means poor service and 5 means excellent service. If you did not deal with a service representative, please select 6.
1
Poor 		2
Fair 		3
Good 		4
Very Good 		5
Excellent 		6
N/A
Knowledge of the product
Courteousness
Willingness to help
Efficiency/quickness
Ability to complete transaction
 
 

Product Background

Which product or products did you purchase?
 
[PRODUCT1]
 
[PRODUCT2]
 
[PRODUCT3]
 
[PRODUCT4]

 
 
How did the product's price compare to your expectations?
Poor Fair Good Very Good Excellent
 
 
 
 
Why was the product purchased?
 
Purchased for self
 
Bought by someone else at my request
 
Gift from someone else
 
Family purchase
 
Business purchase
 
Other
 
 
 
 
Will you please give a brief description of any particular reason (or reasons)
why you choose to purchase [PRODUCT] at this [LOCATION] (instead of elsewhere)?
   
 
 
 
How many times have you purchased from [LOCATION] before?
(Enter 0 if you have not purchased from [LOCATION] before.)
   
 
 
 
How was your overall purchasing experience?
   
 
 
 
Would you purchase another product through the same means?
 
 
 
If you choose 'No' or 'Maybe' for the previous question, will you please
state any particular reason (or reasons)for your choice?
   
 
 
 
Name
   
Address
   
City
   
State
   
Zip
   
Email
   
Phone
   
Fax
   
 
 
 
Questions Comments you might have:
   
 
 
 
Thank you for taking the time to complete this survey! Your results will help us serve you better.
 
 
 
Are you (Check all that apply)
 
married
 
divorced
 
widowed
 
separated
 
single
 
step parent

 
 
The following questions evaluate your views of the store you visited.

Please indicate your opinions about each of the following statements.
COMPANY
Very Strongly Agree Strongly Agree Agree Disagree Strongly Disagree Very Strongly Disagree
Stores are conveniently located.
Store hours are convenient for my shopping needs.
Store atmosphere and decor are appealing.
A good selection of products was present.
(Store) has the lowest prices in the area.
Merchandise sold is of the highest quality.
The merchandise sold is a good value for the money.
Merchandise displays are attractive.
Advertised merchandise was in stock.
Overall, I am very satisfied with the store.
I am very satisfied with the price I paid for what I bought.
I am very satisfied with the merchandise I bought.
Please contact [email protected] if you have any questions regarding this survey.
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