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Questions marked with an * are required Exit Survey
 
When were you born?
* 19
-
 
 
 
*
This is Example of single choice question



How often do you conduct surveys?
 
Weekly
 
Monthly
 
Quarterly
 
Annually
 
Other specify
 
 
 
 
This is example of Multiple choice question


What types of credit cards do you have (Select all that apply)?

 
Visa
 
Mastercard
 
American Express
 
Discover
 
Diners Club

 
 
 
This is example of Multiple choice question with other


What types of credit cards do you have (Select all that apply)?

 
Visa
 
Mastercard
 
American Express
 
Discover
 
Diners Club
 
Other
 

 
 
 
This is example of Multiple choice question with other and exclusive None


What types of credit cards do you have (Select all that apply)?

 
Visa
 
Mastercard
 
American Express
 
Discover
 
Diners Club
 
None
 
Other
 

 
 
 
This is example of Drop Down question


How often do you conduct surveys?

 
 
 
(This is example of Open end question) Comments/Suggestions:
   
 
 
 
(This is example of Single row text question) Name:
   
 
 
 
(This is example of numeric question) How long have you been at your current residence?
   
 
 
 
(This is example of Email Address question) Email Address:
   
 
 
This is example of Grid Single choice per row question


How satisfied are you with the following:

Very Unsatisfied Unsatisfied Neutral Satisfied Very Satisfied N/A
Website
Customer Service
Overall
 
 
This is example of Grid Multiple choice per row question


How satisfied are you with the following:

Very Unsatisfied Unsatisfied Neutral Satisfied Very Satisfied N/A
Website
Customer Service
Overall
 
 
This is example of Grid open ended per row question


How satisfied are you with the following:

Very Unsatisfied Unsatisfied Neutral Satisfied Very Satisfied
Website
Customer Service
Overall
 
 
 
This is example of Ranking question


Please rank (1-3) the following in order of interest:

Skiing
Snowboarding
Biking
 
 
 
This is example of rating question


How satisfied are you with our services?

Very Unsatisfied
Unsatisfied
Neutral
Satisfied
Very Satisfied
 
 
 
This is example of DOB question


What is your date of birth?

 
 
 
ImportanceSatisfaction
Not ImportantVery Important
Not SatisfiedVery Satisfied
1234512345
Customer Service
Product Packaging
On-Time Arrival
 
 
This is example of Slider question


How satisfied are you with the following:

Not at allExtremely
Website
-
Customer Service
-
Overall
-
 
 
*
This is example of US Zip Code list question


Enter a valid zip code

 
 
 
This is example of File upload question


Upload your file below

 
 
 
This is example of NPS question


How likely would you be to recommend our products to a friend or colleague?

«Very UnlikelyVery Likely»
012345678910
 
 
 
This is example of Single choice with Image question type


Which one below you like most?

 
 
 
This is example of Multi choice with Image question type


Are you using services from any of the following service providers (Select all that apply)?


 
 
This is example of Rating with Image question type


Please rate following service providers.