Motivation and Buying Experience TEmplate

Please rate the following characteristics of the service representative on a scale from 1 to 5, where 1 means poor service and 5 means excellent service. If you did not deal with a service representative, please select 6.

	1 Poor	2 Fair	3 Good	4 Very Good	5 Excellent	6 N/A
Knowledge of the product

Courteousness

Willingness to help

Efficiency/quickness

Ability to complete transaction

Product Background

Which product or products did you purchase?

[PRODUCT1]

[PRODUCT2]

[PRODUCT3]

[PRODUCT4]

How did the product's price compare to your expectations?

Why was the product purchased?

Purchased for self

Bought by someone else at my request

Gift from someone else

Family purchase

Business purchase

Other

Buying Experience

Where did you purchase [PRODUCT]?

[LOCATION1]

[LOCATION2]

[LOCATION3]

Other

Will you please give a brief description of any particular reason (or reasons)
why you chose to purchase [PRODUCT] at this [LOCATION] (instead of elsewhere)?

How many times have you purchased from [LOCATION] before?
(Enter 0 if you have not purchased from [LOCATION] before.)

How was your overall purchasing experience?

Would you purchase another product through the same means?

If you chose 'No' or 'Maybe' for the previous question, will you please
state any particular reason (or reasons) for your choice?

Pricing & Product Value

How much did you pay for your product (excluding tax)?

Did you use any coupons or receive a discount of any kind?

Yes

No

How would you rate the overall value of this product?

Name

Address

City

State

Zip

Email

Phone

Fax

Any questions or comments?

Thank you for taking the time to complete this survey! Your results will help us serve you better.