1. Form: Client: ABC co. Online Shopping Habits
  2. Part 1: The Basics HEADLINE
  3. Name *
  4. Email *
  5. Do you make online purchases? {yes, no, maybe, always, sometimes}
  6. Part 2: HEADLINE
  7. Phone *
  8. Best time to reach you [am, pm, weekend, do not call]
  9. Title
  10. Marital status {married, single, rather not say}
  11. NOTE We use this information to better serve our customers
  12. What is your age
  13. NOTE We use this information to better serve our customers
  14. What do you like to do for fun
  15. What is your race
  16. NOTE We use this information to better serve our customers
  17. Did you vote in the last election
  18. What are your political beliefs
  19. What is your annual household income
  20. NOTE We use this information to better serve our customers
  21. What is the fastest and most economical Internet service for you?
  22. What planet would you like to visit
  23. What was your last dream about?
  24. What would you do if you won the lottery?
  25. Would you like to build/design your own house?
  26. Which form of public transport do you prefer?
  27. What talents do you have?
  28. Have you ever been admitted to hospital?
  29. Have you ever had any brushes with the law?
  30. Have you ever been on TV?
  31. Have you ever met any celebrities?
  32. Have you ever been to Legoland?
  33. Have you ever done something heroic?
  34. Have you ever played a practical joke on anyone?
  35. Have you ever been the recipiant of a practical joke?
  36. What would be your best achievement to date?
  37. What did you want to be when you grew up?
  38. If you could change anything about yourself what would it be?
  39. Whats the longest you’ve ever grown your hair?
  40. Are you scared of flying?
  41. Would you rather trade some intelligence for looks or looks for intelligence?
  42. Have you ever tie-dyed your own clothes?
  43. How often do you buy new clothes?
  44. Are you reliable?
  45. Are you proud of yourself?
  46. Can you juggle?
  47. Can you solve a rubix cube?
  48. Part 3: HEADLINE
  49. Street Address
  50. City
  51. State
  52. Zip
  53. Country
  54. Religion
  55. Do you use Facebook {all the time, sometimes, almost never, never}
  56. Do you use Twitter {all the time, sometimes, almost never, never}
  57. Do you use Slack {all the time, sometimes, almost never, never}
  58. Do you use Skype {all the time, sometimes, almost never, never}
  59. Do you use Instagram {all the time, sometimes, almost never, never}
  60. Do you use Yahoo {all the time, sometimes, almost never, never}
  61. Do you use Google Plus {all the time, sometimes, almost never, never}
  62. How did you hear about us? {search, friend, TV ad, other}
  63. Twitter name
  64. Linkedin URL
  65. Would you like to receive our free newsletter? CHECKBOX
  66. Comments TEXTAREA

61 Question form

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