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Customer information form
Dear Sir or Madam, please take a few minutes of your time to complete the following questionnaire.
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1
What is your gender?
Please select your gender from the options below.
Male
Female
Other
2
How would you rate our service?
Please rate our service from 1 to 10.
3
What is your age?
Please provide your age in years.
4
Which of the following products have you purchased from us?
Please select all that apply.
Product A
Product B
Product C
Product D
5
How likely are you to recommend us to a friend or colleague?
Please rate your likelihood from 1 to 10.
6
What is your occupation?
Please provide your current occupation.
7
On a scale of 1 to 5, how satisfied are you with our product quality?
Please rate your satisfaction level.
1
2
3
4
5
8
What is your annual income range?
Please select the range that best represents your annual income.
Less than $25,000
$25,000 - $50,000
$50,000 - $75,000
$75,000 - $100,000
Above $100,000
9
What improvements would you like to see in our services?
Please provide your suggestions for improvement.
10
How did you hear about us?
Please let us know how you learned about our company.
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