z Music X

Information Survey


The purpose of this survey is to collect information from you about something. The purpose of this survey is to collect information from you about something. The purpose of this survey is to collect information from you about something. The purpose of this survey is to collect information from you about something. The purpose of this survey is to collect information from you about something. The purpose of this survey is to collect information from you about something.

This survey is divided into the following sections:

Fill out the information in each section as requested. Then at the end of the form supply your name and contact information, and submit the form. You will receive a confirmation message from us shortly.


SECTION A -- Title of this section

These are the instructions for filling out this section. These are the instructions for filling out this section.These are the instructions for filling out this section.

  1. Who is your favorite band?



  2. How many hours of music do you listen to per week:

    None 1-5 hours 5-10 hours 10-20 hours More than 20 hours

  3. We would like to send you some literature. What is your mailing address?
    Name     
    Street   
    City     
    State    
    Zip Code  
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SECTION B -- Title of this section

These are the instructions for filling out this section. These are the instructions for filling out this section. These are the instructions for filling out this section.

  1. How would you rate this survey?

    Bad Poor Fair Good Excellent

  2. What is your favorite color?



  3. Select the type of music you are most interested in:

    Rock
    Rap
    R&B
    Oldies
    Metal

  4. Here's another way of collecting address info without using fixed-width text:

    Username
    Password
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SECTION C -- Title of this section

These are the instructions for filling out this section. These are the instructions for filling out this section. These are the instructions for filling out this section.

  1. Which music products do you currently own?
    Sony       SKU-04     SKU-07     SKU-10
               SKU-05     SKU-08     SKU-11
    SKU-03     SKU-06     SKU-09     SKU-12
    
  2. Please enter any additional comments regarding our products or services:



  3. Select a month from the following list, which you have recently purchased one of these items:

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FORM SUBMISSION

Thank you for taking the time to answer the questions in our survey.

This explains how we plan to use the information you provide to us. We will also explain what benefits you receive from helping us in this way.

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This Form will only be seen by our company and is completely secure
Copyright © 1999 [Z Music x]. All rights reserved.
Revised: May 29, 2000.