Sample Survey

Sample Vacuum Survey

(Do not fill this out!  Example only!)

Survey Topic: Vacuum Cleaner Features
Number of Questions: 20
Payment to you for Completing Survey: $25

This survey is for people who have carpeting in their home and use a vacuum cleaner.

1. Please supply us with your contact information:
  

Name: 

Address: 

City and State: 

 ZIP Code: 

E-mail: 
2. Do you currently use a vacuum cleaner?
  
Yes
No
Don't know
3. What brand of vacuum cleaner are you currently using?
  
Brand 1
Brand 2
Brand 3
Brand 4
Brand 5
Other
4. How did you purchase your vacuum cleaner?
  
Retail Store
Direct Mail
Catalog
Web
Company
Other
5. Are there features that our "ABC Vacuum Cleaner" does not have that you would want out of a vacuum cleaner?
  
Yes
No
Don't know
6. What features does your vacuum cleaner not have that you wish it did?
  
7. How much did you pay for your vacuum cleaner?
  
8. How satisfied are you with your vacuum cleaner?
  
Very Satisfied
Somewhat Satisfied
Somewhat Dissatisfied
Very Dissatisfied
9. Of the following list of features, please select the top three that would be of interest to you:
  
Feature 1
Feature 2
Feature 3
Feature 4
Feature 5
Feature 6
10. Of the three features you just listed, please rank them first, second and third in importance to you:
  
1.
2.
3.
11. Are there any additional features that would be of importance to you?
  
Additional Feature 1
Additional Feature 2
Additional Feature 3
Additional Feature 4
Additional Feature 5
12. Are there particular features that a vacuum cleaner must have for you to purchase it? Please list what they are in order of importance:
  
Essential Feature 1
Essential Feature 2
Essential Feature 3
Essential Feature 4
Essential Feature 5
13. How much would you be willing to pay for a vacuum cleaner with these features: low-maintenance, never loses suction, lifetime guarantee?
  
14. If our "ABC Vacuum Cleaner" was priced at $250 how likely, on a percentage basis, would you be to buy it?
  
(0% = Not at all likely to buy, 100% = Completely likely to buy)
15. How much are you authorized to spend on a vacuum cleaner?
  
16. What do you think about the price of our "ABC Vacuum Cleaner"?
  
Extremely Low
Somewhat Low
Just right
Somewhat High
Extremely High
17. Through what means would you be most likely to purchase our "ABC Vacuum Cleaner"?
  
Retail
Direct Mail
Mail Order Catalog
Classified Advertisement
Telemarketer
18. Through what means would you be least likely to purchase our "ABC Vacuum Cleaner"?

Retail
Direct Mail
Mail Order Catalog
Classified Advertisement
Telemarketer
19. What do you think would be another good name for "ABC Vacuum Cleaner"?

20. Can you please tell us which one of the following possible product names you like the most?

Product 1
Product 2
Product 3
Product 4
Product 5
Thank you for taking the time to participate in our survey about vacuum cleaner features.

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