Motivation and Buying Experience

1. Question 1.

On a scale of 1 to 5, with 1 being poor and 5 being excellent, please rate the following characteristics of your sales representative.

1

2

3

4

5

N/A

Knowledge of the product

1

2

3

4

5

N/A

Courteousness

1

2

3

4

5

N/A

Helpfulness

1

2

3

4

5

N/A

Quickness and efficiency

1

2

3

4

5

N/A

Ability to complete transaction

1

2

3

4

5

N/A

2. Question 2.

Please list the products that you have purchased

3. Question 3.

Why was the product bought (select one only)?

For Myself

Bought for Me by Someone Else Following My Request

As a Gift to Me

For the Family

For Business

Other (please specify):

This is required

Input box for - Other (please specify):

4. Question 4.

Where was the product purchased?

5. Question 5.

Please indicate why you purchased this product in this location

6. Question 6.

How often have you shopped here before?

Very Often

Often

Infrequently

Less Often

Never

7. Question 7.

Please comment on your overall experience.

8. Question 8.

Would you purchase a different product in the same manner?

Yes

No

Perhaps

9. Question 9.

If you chose “no” or “perhaps”, could you tell us why?

10. Question 10.

How much did you pay for your product?

11. Question 11.

Did you receive a discount or did you use coupons?

Discount

Coupons

N/A

12. Question 12.

How would you rate the value of your product?

Very Low

Low

Average

High

Very High

13. Question 13.

Please use this space to include any questions or comments you may have about the survey or your responses.

14. Question 14.

All your answers will be held in the strictest of confidentiality. If, however, you wish us to contact you to discuss any questions you may have, please complete the form below.

Name:

Address:

City:

State/County:

Postcode/Zip:

Email:

Telephone Number: