Services - Customer's Section: Survey Form

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CCTV Demo

Reliant CCTVs

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Reliant CCTVs are reliable and affordable.

Customer's Info

Customer's Survey

We will use the results from this Customer'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. Have you recently purchased a CCTV from us?	Yes	No
2. Will you be purchasing a CCTV within the next six months?	Yes	No
3. Are you shopping for someone else?	Yes	No
4. Do they have macular degeneration?	Yes	No
5. Are they 50 years or older?	Yes	No
6. Do you know that they get $100 off the list price?	Yes	No
7. Do they need help setting it up and learning how to use it?	Yes	No
8. Did the volunteer dispenser provide quality service?	Yes	No
9. Did you find this site through a search engine?	Yes	No
10. Did you find this site through the AARP?	Yes	No
11. Did you find this site through the Lions?	Yes	No
12. Did you find this site through an affiliate?	Yes	No
13. Did you find this site through an eye doctor's office?	Yes	No
14. Did this site answer all your questions?	Yes	No
15. Was this site easy to use?	Yes	No
16. Did you use the "CCTV Demo" section effectively?	Yes	No
17. Would you recommend this site to a friend?	Yes	No
18. Do you know you may become an affiliate for free?	Yes	No
19. Do you know affiliates get commissions for sales?	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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