Date:

Survey Subject:

Key Contact:

Company:

Address:

Phone:

City:

Fax:

State:

Email:

Zip:

Email with attached results report
Online Webcast Presentation

Hardcopy & CD sent via UPS
Face-to-face presentation

Overall objective of the survey:

Specific information to be obtained (end result) from this survey?

What decisions will be made based on the survey results?

What measure(s) will drive decisions (i.e. Purchase Intent,
Product Appeal, Product Uniqueness, etc.)?

What is the success criteria? What determines a Go/No Go decision?

Will digital photos be provided to be included in the survey?

Yes
No

What are the specific demographic requirements?

Country?

Australia Austria Belgium Canada China Denmark Finland France Germany Ireland Italy Netherlands Norway Poland Spain Sweden Switzerland UK USA