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When was your most recent purchase from [COMPANY A]?
 
Less than 1 month ago
 
1 - 3 months ago
 
4 - 6 months ago
 
7 months to a year ago
 
More than a year ago
 
 
 
Which of the following items have you purchased from [COMPANY A] in the past year? Select all that apply.
 
Jeans/pants
 
Skirt
 
Top/tee
 
Sweater
 
Outerwear
 
Shoes
 
Accessory
 
I have not purchased any of these items in the past year
 
Other
 

 
 
 
If you have NOT purchased a product from {COMPANY A} within the past year, which statement best explains why?
 
I haven't needed any product similar to the one I bought before
 
I wasn't satisfied with the quality of {COMPANY A's} product
 
I wasn't satisfied with the quality of my previous purchase experience
 
Shopping at {COMPANY A} is not convenient for me
 
{COMPANY A} does not have what I am looking for
 
{COMPANY A's} products are too expensive
 
Don't know/haven't thought about it
 
Other
 
 
 
 
Which of the following explains why you made your most recent purchase?
 
For myself
 
For my child
 
As a gift for a friend
 
Other
 
 
 
 
How did you make your most recent purchase?
 
Online
 
By phone
 
By mail/catalogue
 
In-person/in-store
 
Through a dealer
 
Other
 
 
 
 
We are introducing a new product, {ENTER NEW PRODUCT NAME AND DESCRIPTION}. How interested would you be in purchasing this item?
 
Very interested
 
Somewhat interested
 
Neutral
 
Somewhat uninterested
 
Very uninterested
 
 
 
What would be an appropriate price range for this product?
 
{PRICE RANGE 1}
 
{PRICE RANGE 2}
 
{PRICE RANGE 3}
 
{PRICE RANGE 4}
 
{PRICE RANGE 5}
 
I would not pay for this product
 
 
 
Is there anything that does not appeal to you about this product? If so, what?
   
 
 
 
Is there another attribute that you would like to see? If so, what?
   
 
 
 
Please indicate your gender.
 
Male
 
Female
 
Prefer not to answer
 
 
 
Which of the following includes your age?
 
Younger than 18
 
18 - 24
 
25 - 34
 
35 - 44
 
45 - 54
 
55 - 64
 
65 or older
 
Prefer not to answer
 
 
 
What is the highest level of education you have completed?
 
Some high school
 
High school graduate
 
Some college
 
College graduate
 
Any post-graduate work
 
Prefer not to answer
 
 
 
Which of the following categories includes the total annual income of your household before taxes?
 
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
 
 
 
Do you have children under the age of 18?
 
Yes
 
No
 
 
 
Please share any additional comments for improvements.
   
 

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