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  5. test survey 5 oct 2015 1
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Instructions/Header
How often do you conduct surveys?
 
Weekly
 
Monthly
 
Quarterly
 
Annually
 
qwer
 
wqe
 
qwerty
 
 
 
What types of credit cards do you have (Select all that apply)?
 
Visa
 
Mastercard
 
American Express
 
Discover
 
Diners Club

 
 
 
 
 
 
How often do you conduct surveys?
 
 
 
What types of credit cards do you have (Select all that apply)?
Visa
Mastercard
Option 1
Option 2
 
 
 
How often do you conduct surveys?
Weekly
Monthly
Option 11
Option22
 
 
How satisfied are you with the following:
qwerty1
qwerty2
 
 
 
How often do you conduct surveys?
 
 
 
Comments/Suggestions:
   
 
 
 
Name
   
sdaDS
   
 
 
 
How many months have you been at your current residence?
   
 
 
Step 1 of 1
For each of the questions below, please choose your most and least preferred option
MostLeast
Visa
Mastercard
Discover
American Express
 
 
 
Email Address
   
 
 
How satisfied are you with the following:
Very Dissatisfied Not Satisfied Neutral Satisfied Very Satisfied
Website
Customer Service
Overall
 
 
How satisfied are you with the following:
Very Dissatisfied Not Satisfied Neutral Satisfied Very Satisfied
Website11
Customer Service 11as
Overall11
 
 
How satisfied are you with the following:
Very Dissatisfied Not Satisfied Neutral Satisfied Very Satisfied
Website
Customer Service
Overall
 
 
 
ImportanceSatisfaction
Not ImportantVery Important
Not SatisfiedVery Satisfied
1234512345
Customer Service
Product Packaging
On-Time Arrival
 
 
How satisfied are you with the following:
Website
Customer Service
Overall
 
 
How satisfied are you with the following:
Very Dissatisfied Not Satisfied Neutral Satisfied Very Satisfied
Website
-
Customer Service
-
Overall
-
 
 
How satisfied are you with the following:
Overall
 
 
How satisfied are you with the following:
Website
-
Customer Service
-
Overall
-
 
 
 
Please rank (1-3) the following in order of interest:
Drag your choices here to rank them
     
     
     
    What do you think of Starbucks?
    Love it
    Hate It
     
     
     
    How satisfied are you with our services
    Extremely Unsatisfied
    Unsatisfied
    Neutral
    Satisfied
    Extremely Satisfied
     
     
     
    Please rank (1-3) the following in order of interest:
    Skiing
    Snowboarding
    Biking
     
     
     
    Please allocate 100 points on how you spend your income:
    Essentials (Gas, Grocery etc.)
    Entertainment (Movies, Clubs etc.)
    Other
    0
     
     
     
    What is your date of birth?
     
     
    Contact Information
    First Name : 
    Last Name : 
    Address 1 : 
    Address 2 : 
    City : 
    State : 
    Zip : 
    Phone : 
    Email Address : 
     
     
     
    Select Captcha and Verify
       
     
     
     
    What is your date of birth?
     
     
     
    Considering your complete experience with our company, how likely would you be to recommend our products to a friend or colleague?
    «Very UnlikelyVery Likely»
    012345678910
     
     
    At what price would you consider the Product
    $1000 - $12000 $1200 - $15000 $1500 - $25000 $2500 - $35000 $3500 - $50000
    At what price is the product too expensive to consider? (Too Expensive)
     
    At what price is the product so cheap that the product quality is questionable? (Too Inexpensive)
     
    At what price does the product begin to seem too expensive? (Expensive)
     
    At what price is the product a bargain? (Inexpensive)
     
     
     
    For each transportation category in the table below, please indicate what percentage, if any, of the need you would fund
    Total Needed
    PER YEAR    		Cost to
    Fund 100%
    PER MONTH
    Preservation and maintenance of existing transport system
    -
    		 1000.0 10
    Adding new lanes and expanding road and bridge capacity
    -
    		 2000.0 20
    Increasing transit service and expanding passenger and freight rail
    -
    		 3000.0 30
    Making bike and sidewalk improvements
    -
    		 4000.0 40
    Replacing obsolete ferries and improving ferry terminals
    -
    		 5000.0 50
     
     
     
    Descriptive/Spacer Text Here
     
     
     
    Descriptive/Spacer Text Here
     
     
     
    Descriptive/Spacer Text Here
     
     
    Step 1 of 1
    For each of the questions below, please choose your most and least preferred option
    MostLeast
    Visa
    Mastercard
    Discover
    American Express
     
    Step 1 of 2
    If you were to buy a TV, select the most likely feature set you would go with:
    Brand Sony Vizio
    PriceUSD 1,200.00USD 1,200.00
    Size45''45''
     
     
    TubePulse
     
    1
    3
     
     
       
       
       
      Please drag/ crop the area of your interest on the image:
       
       
       
      Please like/dislike predefined selected areas on the image considered for Hot Spots:
       
       
       
       
      How much time does it take you to shop for groceries?
         
       
       
       
      Please scan the Barcode.
         
       
       
       
      Please scan QR code
       
      		 
       
       
       
      Enter in your salary:
      Base $
      Bonus/Commission $
       
       
      Please enter in info to join the community
      First Name : 
      Last Name : 
      Email Address : 
       
       
      Complex Grid / Flex Matrix
      Rating Scale Drop Down MenuVertical Attribute ChoiceVertical Attribute (Multi-Select Checkbox) Numeric Text Input Comment Box Interactive Slider (Horizontal) Rank Order
      1234
      Product Packaging
      On-Time Arrival
      Price
       
       
      Enter a valid zip code
       
       
      Please select an option from the drop down menu below. After selecting an option, another drop down list will be displayed below. Select an appropriate option from that list as well.