Customer Profile Survey

Thank you for agreeing to take the [Company] customer survey. All the answers you provide are anonymous and confidential.

1. What best describes your employment status?

Employed full time

Employed part time

Not employed

Retired

Student

Homemaker

2. What best describes your level of education?

Some high school

High school graduate or equivalent

Trade or Vocational degree

Some college

Associate degree

Bachelor's degree

PhD

3. In which industry do you work?

4. Which of the following best describes your job role?

5. What is your job title?

Top Level Executive

Senor Vice President

Vice President

Director

Manager

Professional

Administrative/Support personnel

Other: please pecify

6. How long have you worked for your current company?

Less than 3 months

3 months to 6 months

More than 6 monts to 12 months

Over 1 year to 3 years

Over 3 years to 5 years

More than 5 years

7. How large is your current company?

Under 5 employees

6-20 employees

21-50 employees

51-100 employees

More than 100 employees

8. What is the annual revenues of your company?

Under $100,000

$100,000 to $500,000

Over $500,000 to $1 Million

Over $1 Million to $10 Million

Over $10 Million to $50 Million

Over $50 Million to $100 Million

Over $100 Million

Don't know / Prefer not to answer

9. Where is your company located? If you work in a branch office, please provide that location.

City

State/Region

Zip/Postal Code

10. Which of the following includes your age?

17 or under

18-24

25-34

35-54

55+

11. Which of the following best describes your ethnicity?

Asian/Pacific Islander

Black/African-American

Caucasian

Hispanic

Native American/Alaska Native

Other/Multi-Racial

Prefer not to answer

12. What is your gender?

Male

Female

13. How long have you been a customer of our company?

Less than 6 months

Between 6 months and a year

Between 1 and 3 years

More than 3 years

14. Overall, how satisfied are you with our products/services?

Very Satisfied

Somewhat Satisfied

Neutral

Somewhat Dissatisfied

Very Dissatisfied

Very Satisfied

Somewhat Satisfied

Neutral

Somewhat Dissatisfied

Very Dissatisfied

15. If our company could improve in one way, what would you find to be most valuable?

Thank You!

Thank you for taking our survey. Your feedback is very important to us.