Sample Survey

Instructions

This web survey form demonstrates the online surveying capabilities of SurveyGold. As you can see, web survey forms support single- and multi-select dropdown menus, checkboxes and single- and multi-line fill-in-the-blank fields, and a matrix of radio buttons. You can make questions and respondent data (e.g., name, email, etc.) in web survey forms required or optional. The first three numbered questions in this survey are required.

To submit your responses to this survey, click the button at the bottom of the web form. Try submitting the survey without entering responses and then with partial responses to see how SurveyGold handles required questions. Note that you can specify a custom confirmation page to display to your respondents after responses are submitted.

Please provide the following

First Name

Last Name

About You

Your Age

2.	Your Gender

	Female
	Male
	Other

Your Role

	(Hold down the CTRL key and select all that apply.)

About Your Business

4.	How many employees are at your location?

	1
	10 or less
	11-50
	51-500
	501-5000
	5001 or more

About Your Usage of Our Product

5.	How satisfied are you with our product?

	Very Satisfied
	Satisfied
	Neither
	Unsatisfied
	Very Unsatisfied

6.	What three things do you like most about our product?

	(Provide up to three responses.)

7.	What factors motivated you to purchase our product?

	( Select all that apply.)
	Price
	Value
	Brand Name
	Recommendation
	Readily Available
	Other:

8.	How likely are you to buy from us again?

	Very Unlikely
	Unlikely
	Neither
	Likely
	Very Likely

Your Opinions

This section shows an example of the matrix presentation style.

Strongly Agree

Agree

Neither

Disagree

Strongly Disagree

9.	I like the way the product looks

10.	I like the way the product feels

11.	I like the price of the product

Created with SurveyGold - �2008 Golden Hills Software, Inc. - http://surveygold.com