Randomization

1. What is your gender?

Male

Female

2. What is your date of birth?

Month	Day	Year

3. What do you think of Starbucks?

Love it

Hate it

4. Descriptive / Spacer Text Here

First Name :

Last Name :

Address 1 :

Address 2 :

City :

State :

Zip :

Phone :

Email Address :

6. How satisfied are you with our services?

7. How often do you conduct surveys?

Weekly

Monthly

Quarterly

Annually

8. What types of credit cards do you have (Select all that apply)?

9. How often do you conduct surveys?

10. Comments/Suggestions:

11. How satisfied are you with the following:

12. Please rate the following:

Books

Movies

Music