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Sample Survey #1 (Do not fill this out!)
Survey Topic: Personal Shopping Number of Questions: 20 Payment for Completing Survey: $20.00
E-Mail address First Name Last Name Mailing address City, State Zip
1. What is your Gender? Male Female
2. Which of the following ranges includes your age? 18-24 25-31 32-40 41or Older
3. Which grocery store do you most frequently shop at? Kroger Randall's Albertsons Hughes Ralphs Safeway Stater Brothers Vons Other (please specify)
4. How often do you shop for groceries per month? 5 times a month 4 times a month 3 times a month twice a month once a month less often than once month
5. On average, how much money do you spend on groceries in total per month? under $50 $50 to $100 $101 to $200 $201 to $300 $301 to $400 $401 to $500 $501 or more
6. Are online grocery shopping services available in your area? Yes No Don't know
7. Have you ever shopped online for groceries? Yes No
8. When you purchase groceries, do you generally...? Purchase only items you intended to purchase prior to going to the grocery store Purchase additional items that you see while you are browsing Purchase additional items that you see advertised
9. Have you ever pulled coupons or special offers from newspapers to use when shopping for groceries? Yes No
10. Does the grocery store you visit most frequently offer a frequent shopper program? Yes No
11. How would you rate the customer service at the grocery store you frequently shop at? Excellent Very Good Average Poor
12. Which pharmacy/drugstore do you most frequently shop at? Eckerds Longs Osco Rite Aid Savon Walgreen Other (please specify)
13. How often do you shop for pharmacy/drugstore products per month? 5 times a month 4 times a month 3 times a month twice a month once a month less often than once month
14. On average, how much money do you spend on pharmacy/drugstore products in total per month? under $50 $50 to $100 $101 to $200 $201 to $300 $301 to $400 $401 to $500 $501 or more
15. Are online pharmacy/drugstore services available in your area? Yes No Don't know
16. Have you ever shopped online for pharmacy/drugstore products? Yes No
17. When you purchase pharmacy/drugstore products, do you generally...? Purchase only items you intended to purchase prior to going to the grocery store Purchase additional items that you see while you are browsing Purchase additional items that you see advertised
18. Have you ever pulled coupons or special offers from newspapers to use when shopping for pharmacy/drugstore products? Yes No
19. Does the pharmacy/drugstore you visit most frequently offer a frequent shopper program? Yes No
20. How would you rate the customer service at the pharmacy/drugstore you frequently shop at? Excellent Very Good Average Poor
Thank you for taking the time to participate in our survey about personal shopping.