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How long have you been purchasing our services?
Less than 6 months
6 months to less than 1 year
1 year to less than 3 years
3 years to less than 5 years
5 years or more
How often do you use our services?
Don't Use
Daily
Weekly
Monthly
Quarterly
{OPTION 1}
{OPTION 2}
{OPTION 3}
{OPTION 4}
{OPTION 5}
Where do you purchase our services?
In our store
Online
Telephone order/catalogue
Through a dealer
Through an agent
Through a wholesaler
Other
How would you rate your overall level of satisfaction with us?
Highly satisfied
Somewhat satisfied
Neutral
Somewhat dissatisfied
Highly dissatisfied
How do we rate on the following attributes?
Well Below Average
Below Average
Average
Above Average
Well Above Average
Customer service experience
On-time delivery of service
Professionalism
Purchase experience
Quality of service
Understanding of customers' needs
How do we rate in comparison to other companies that offer the same services?
Much higher
Somewhat higher
Same
Somewhat lower
Much lower
Don't know
How likely are you to continue using our services?
Very likely
Somewhat likely
Neutral
Somewhat unlikely
Very unlikely
Have you ever recommended us to others?
No, never recommended
Have recommended once or twice
Have recommended several times
Do you have any suggestions for improvement?
What is your gender?
Male
Female
Prefer not to answer
What is your age?
Younger than 18
18 - 24
25 - 34
35 - 44
45 - 54
55 - 64
65 or older
Prefer not to answer
What best describes your employment status?
Employed full-time
Employed part-time
Self-employed
Unemployed, looking for work
Unemployed, not looking for work
Student
Retired
Homemaker
Military
Prefer not to answer
Other
Which of the following categories best describes your annual income?
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
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