1. Do you currently use any [Product]?

Yes  No  Not Sure 

    2. What brand of [Product] are you currently using?

Brand 1  Brand 2  Brand 3  Brand 4  Brand 5 

    3. How did you purchase this product?

Retail Store     Direct Mail      Catalog

Web               Company        Someone Else Purchased

Not Sure

    4. Are there features that this product does not have that you would want
        out of a [Product]?

Yes  No  Not Sure 

    5. What features does your [Product] not have that you wish it did?

    6. How much did you pay for your [Product]?

    7. How satisfied are you with your [Product]?

Very Satisfied  Somewhat Satisfied  Somewhat Dissatisfied  Very Dissatisfied 

    8. 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

    9. Of the three features you just listed, please rank them first, second and
        third in importance to you.

First	

Second	

Third	

   10. 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	

    11. Are there particular features that a product 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. If the product was priced at (price) how likely, on a percentage basis,
          would you be to buy it?
          (0% = Not at all likely to buy, 100% = Completely likely to buy)

    14. How much are you authorized to spend on new products?

   15. Do you think a price of (price) for this is product is Extremely High,
          Somewhat High, Just Right, Somewhat Low, Extremely Low?

Extremely High  Somewhat High  Just Right  Somewhat Low  Extremely Low 

    16. Through what means would you be most likely to purchase
          this product?

Retail  Direct Mail  Mail Order Catalog  Classified Advertisement  Telemarketer 

    17. Through what means would you be least likely to purchase
          this product?

Retail  Direct Mail  Mail Order Catalog  Classified Advertisement  Telemarketer 

    18. What do you think would be a good name for such a product?

    19. On a scale of 1 to 5, where 1 means Not at all and 5 means
          Very much, how would you rate your preference for the
          following product names?

1  2  3  4  5    Product Name 1

1  2  3  4  5    Product Name 2

1  2  3  4  5    Product Name 3

1  2  3  4  5    Product Name 4

1  2  3  4  5    Product Name 5

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

Product Name 1  Product Name 2  Product Name 3  Product Name 4  Product Name 5 

    21. How often do you read product reviews?

Once a day  Once every couple of days  Once a week  Once every couple of weeks  Once a month  Once every couple of months  Twice a year  Once a year  Less than once a year  Don't read product reviews 

    22. How likely would you be to base a purchasing decision on a
          product review?

Extremely Likely  Very Likely  Somewhat Likely  Not Very Likely  Not At All Likely  Don't Read Product Reviews 

    23. How much of your knowledge about new products comes from reading
         product reviews?

All of it  Most of it  Some of it  Not much of it  None of it 

   24. Which of the following publications do you read that review
          products?

Publication 1	Publication 2
Publication 3	Publication 4	Publication 5

   25. Please supply us with your contact information.  

Name
Title
Organization
Address
City, State Zip
E-Mail
Phone
Fax