How interested are you in our new products?
Very Interested Somewhat Interested Neutral Not Interested
How do you rate our product quality?
Excellent Good Average Poor
Which product improvement do you suggest?
Better Quality More Features Lower Price Improved Design
How likely are you to purchase?
Very Likely Likely Undecided Unlikely
Would you recommend us to others?
Definitely Yes Maybe Not Sure No
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Name
Email
Phone
(Details here)
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