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How often could you find a use for this [Product/Service]?
 
Once a week or more often
 
2-3 times a month
 
Once a month
 
Every 2-3 months
 
2-3 times a year
 
Once a year
 
Do not use
 
 
 
Based on the description, how interested would you be in buying this new [Product/Service] if priced within your budget?
 
Not at all interested
 
Not very interested
 
Not sure
 
Somewhat interested
 
Very interested
 
 
 
What is it that you like most about the [Product/Service]?
   
 
 
 
Which of the following best describes your need for this product?

 
I really need this product because nothing else can solve this problem.
 
This is a minor improvement over what I currently use.
 
Looks okay but is about the same as what I'm using now.
 
My current product would serve me better.
 
I am not at all interested in this product.
 
 
 
About what would you expect to pay for a new [Product/Service] like the one described? (Nearest dollar)
   
 
 
 
At what price would this new product begin to look inexpensive or cheap? Select one.
 
FMV + 30%
 
FMV + 20%
 
FMV + 10%
 
FMV + 5%
 
[Enter estimated FMV]
 
FMV - 5%
 
FMV - 10%
 
FMV - 20%
 
FMV - 30%
 
 
 
If you knew that the average price of [Product/Service] was $[Enter Price], would you expect to pay more or less to buy the described product/service?
 
(20-30%) more
 
(5-10%) more
 
No more, no less
 
(5-10%) less
 
(20-30%) less
 
 

Is your home
 
a single family house
 
a two family house
 
an apartment
 
a mobile home
 
Other
 
 
 
 
Are you (Check all that apply)
 
married
 
divorced
 
widowed
 
separated
 
single
 
step parent

 
 
 
Were the survey instructions and choices adequate for you to complete the survey without further questions?
 
Yes
 
No
 
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