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Have you purchased or used {PRODUCT/SERVICE NAME} within the past year?
 
Yes
 
No
 
 
 
How interested are you in purchasing this {PRODUCT/SERVICE DESCRIPTION} within a year?
 
Very interested
 
Somewhat interested
 
Neutral
 
Somewhat uninterested
 
Very uninterested
 
 
 
Which statement best explains why you are or are not interested in purchasing this product?
 
{REASON 1}
 
{REASON 2}
 
{REASON 3}
 
{REASON 4}
 
{REASON 5}
 
 
How important are each of the following factors when selecting a {PRODUCT/SERVICE NAME}? Please rank in order of importance.
Least important Most important
{FACTOR 1}
{FACTOR 2}
{FACTOR 3}
{FACTOR 4}
{FACTOR 5}
 
 
Would the {PRODUCT/SERVICE} be more or less appealing if it had any of the following attributes?
Much less appealing Somewhat less appealing Neutral Somewhat more appealing Much more appealing
{ATTRIBUTE 1}
{ATTRIBUTE 2}
{ATTRIBUTE 3}
{ATTRIBUTE 4}
{ATTRIBUTE 5}
 
 
 
What would be an appropriate price for this {PRODUCT/SERVICE} if it includes all of the attributes mentioned above?
 
{PRICE 1}
 
{PRICE 2}
 
{PRICE 3}
 
{PRICE 4}
 
{PRICE 5}
 
 
 
Are there any other attributes that would make you more likely to purchase this {PRODUCT/SERVICE}. If so, what?
   
 
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