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0%
 
 
My family income is:

 
under $25,000
 
$25,000 - $39,999
 
$40,000 - $59,999
 
$60,000 - $79,999
 
$80,000 - $99,999
 
$100,000 and over
 
 
 
Marital Status
 
Married
 
Single
 
Other
 
 
 
Sex
 
Male
 
Female
 
 
 
Overall, how would you rate your satisfaction with our customer service representative.
 
Extremely satisfied
 
Satisfied
 
Neutral
 
Unsatisfied
 
Extremely unsatisfied
 
Not Sure
 
 
 
Do you have comments or suggestions that would help us improve our customer service?
   
 
 
 
Overall, I am very satisfied with the way [COMPANY] performed (is performing) on this project.
 
Strongly disagree
 
Somewhat disagree
 
Neutral
 
Somewhat agree
 
Strongly agree
 
N/A
 
 

Branching: High School Graduates and Above


Education
Which of the following best describes the highest level of education completed?
 
Some High School
 
High School Graduate
 
Some College
 
Graduated College
 
Post Graduate
 
 

Family Status
Which of the following statements applies to you:
 
I have children under the age of 6 living at home
 
I have children between the ages of 6 and 17 living at home
 
I have no children under the age of 18 living at home
 
 

Online Services
a. Do you log on and use the Internet by yourself, without help, at either work or home?
 
Yes
 
No
 

b. How long have you been using the Internet, by yourself?
 
Less than 6 months
 
6 � 12 months
 
1 - 2 year
 
More than 2 years
 

c. How often do you use the Internet, not including email, by yourself, either at work or at home?
 
Less than one hour/week
 
1 � 2 hours/week
 
2 � 3 hours/week
 
More than 3 hours/week
 
 
Have you ever ordered [PRODUCT] from [COMPANY]?
 
Yes
 
No
 
 
 
Overall, how would you rate [COMPANY]?
 
Excellent
 
Good
 
Average
 
Poor
 
Terrible
 
Not Sure
 
 
 
For your NEXT [PRODUCT] purchase, how likely are you to purchase from [COMPANY]?
 
Definitely would buy
 
Probably would buy
 
Might or might not buy
 
Probably would not buy
 
Definitely would not buy
 
N/A
 
 
 
Which of the following modes did you use to place the order for [PRODUCT]?
 
Mail order
 
Internet
 
Over the phone
 
Fax
 
Other
 
 
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