Services - Affiliate's Section: Survey Form

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Affiliates's Survey

We will use the results from this Affiliate's Survey to enhance our services. Your cooperation is appreciated. If you wish to receive a free calendar (11" X 17" ) please indicate so at the end of the survey. You only need to provide your name and shipping information if you want the free calendar. If you have any questions please let me know how to reach you. Thanks.

1. Are you already a VisionAid.com Affiliate?	Yes	No
2. Have you recently sold a Reliant CCTV?	Yes	No
3. Will you be selling a CCTV within the next six months?	Yes	No
4. Are you using our free Affiliate's web page?	Yes	No
5. Do you have a website?	Yes	No
6. Do you have more than one website?	Yes	No
7. Do you have any sub-affiliates?	Yes	No
8. Are you 50 years or older?	Yes	No
9. Are you an AARP member?	Yes	No
10. Do you know that "Seniors" ( those 50 or older ) get $100 off the list price on a CCTV purchase and a one year membership to AARP?	Yes	No
11. Do you know that if your customer needs help setting it up and learning how to use the CCTV that our network of "Volunteer CCTV Dispensers" are ready to help?	Yes	No
12. Did you find this site through a search engine?	Yes	No
13. Did you find this site through the AARP?	Yes	No
14. Did you find this site through the Lions?	Yes	No
15. Did you find this site through an Affiliate?	Yes	No
16. Did you find this site through an eye doctor's office?	Yes	No
17. Did this site answer all your questions?	Yes	No
18. Was this site easy to use?	Yes	No
19. Did you use the "Demo CCTV" section effectively?	Yes	No
20. Would you recommend this site to a friend?	Yes	No
21. Do you need promotional material?	Yes	No
Do you want someone to contact you?	Yes	No
If so, please provide your phone #:
... or your email address:
Do you want a free 11" X 17" calendar?	Yes	No
If so, please provide your name and shipping address below
Name:
Address:
City:
State:
Zip:

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