Motivation and Buying Experience Survey Template

Motivation and buying experience survey based on product, price, and experience.



   
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]

 
   
Overall, how would you rate the product?
Poor Fair Good Very Good Excellent
 
 
   
 
What was the reason to purchase the product?
 
Personal purchase
 
Business purchase
 
Purchased as gift
 
Purchased by someone else at my request
 
Other
    
 
   
 
Buying Experience


Where did you purchase [PRODUCT]?
 
[LOCATION1]
 
[LOCATION2]
 
[LOCATION3]
 
Other
    
 
   
 
Could you please explain the particular reason (or reasons) you choose 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 at [LOCATION]?
 
   
 
If you chose 'No' or 'Maybe' for the previous question, could you please
state any particular reason (or reasons) for your selection?
   
 
   
 
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?
Very high value Somewhat high value Neutral Somewhat low value Very low value
 
   
 
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.
 

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