You are on page 1of 6

CUSTOMER RESPONSE FORM

1. What is your age?


20-25
25-30
30-35
40-45
45-50
Above 50
2. What is your current marital status?
Single
Married
Divorced
3. What is the highest level of education completed by you?
No Schooling
Middle School
High School
Intermediate
Bachelors
Masters
PhD
4. What is your current status of employment?
Unemployed
Homemaker
Student
Self employed
Salaried
Retired
5. What is your monthly household income (In Rupees)?
Less than 20,000
20,000-49,999
50,000-99,999
100,000-200,000
Above 200,000

6. What is the number of children living in your household?


0-2
3-5
6-8
9-10
More than 10
7. How many hours per day, do you spend on social media e.g. Facebook?
a. Less than 2
b. 2 4
c. 4 - 6
d. More than 6
8. Do you own a smartphone and a tablet?
Smartphone only
Tablet only
Both
Neither
9. How many hours per day, do you spend on TV?
Less than 2
24
4-6
More than 6
10. What do you watch on TV?
News
Sports
Dramas
Morning Shows
11. How many hours per day, do you allow your children to watch TV?
Do not allow them
1-2
2-3
More than 3
12. Is your child a social media user?
Yes
No

13. Which form of education do you prefer for your children?


Interactive digital based learning
Traditional textbook
14. How many times a week does your child have food meal that is not home-made?
Once
Twice
Thrice
More than 4 times
15. Kindly score the following options on a scale 0f 1 to 7 (1 being the worst and 7 being the
best)

Profile Number 1
Card ID
Milk Type
1 Regular

Packaging
Usage
Tetrapack Drinking
Milk

Price
Rs.110/litre

Profile Number 2
Card ID
Milk Type
2 Regular

Packaging
Usage
Bottled
All
Purpose

Price
Rs.110/litre

Profile Number 3
Card ID
Milk Type
3 Regular

Packaging
Usage
Tetrapack Tea

Price
Rs.120/litre

Profile Number 4
Card ID
Milk Type
Packaging
Usage
4 Fortified (With
Bottled
Tea
added
Vitamins/Minerals)

Price
Rs.32/250ml

Profile Number 5
Card ID
Milk Type
5 Low Calorie

Packaging
Usage
Bottled
Tea

Price
Rs.110/litre

Profile Number 6
Card ID
Milk Type
Packaging
Usage
6 Fortified (With
Tetrapack All
added
Purpose
Vitamins/Minerals)

Price
Rs.28/250ml

Profile Number 7
Card ID
Milk Type
7 Regular

Packaging
Usage
Bottled
All
Purpose

Price
Rs.120/litre

Profile Number 8
Card ID
Milk Type
8 Regular

Packaging
Usage
Pouch
Tea

Price
Rs.28/250ml

Profile Number 9
Card ID
Milk Type
9 Regular

Packaging
Usage
Bottled
All
Purpose

Price
Rs.28/250ml

Profile Number 10
Card ID
Milk Type
Packaging
Usage
10 Fortified (With
Bottled
Drinking
added
Milk
Vitamins/Minerals)

Price
Rs.120/litre

Profile Number 11
Card ID
Milk Type
11 Low Calorie

Packaging
Usage
Pouch
All
Purpose

Price
Rs.120/litre

Profile Number 12
Card ID
Milk Type
12 Regular

Packaging
Usage
Pouch
Drinking
Milk

Price
Rs.32/250ml

Profile Number 13
Card ID
Milk Type
13 Low Calorie

Packaging
Usage
Tetrapack All
Purpose

Price
Rs.32/250ml

Profile Number 14
Card ID
Milk Type
14 Low Calorie

Packaging
Usage
Bottled
Drinking
Milk

Profile Number 15
Card ID
Milk Type
Packaging
Usage
15 Fortified (With
Pouch
All
added
Purpose
Vitamins/Minerals)

Price
Rs.28/250ml

Price
Rs.110/litre

Profile Number 16
Card ID
Milk Type
16 Regular

Packaging
Usage
Bottled
All
Purpose

Price
Rs.32/250ml

Profile Number 17
Card ID
Milk Type
17 Low Calorie

Packaging
Usage
Bottled
All
Purpose

Price
Rs.28/250ml

Profile Number 18
Card ID
Milk Type
18 Low Calorie

Packaging
Usage
Bottled
Drinking
Milk

Profile Number 19
Card ID
Milk Type
Packaging
Usage
19 Fortified (With
Bottled
Drinking
added
Milk
Vitamins/Minerals)

Price
Rs.120/litre

Price
Rs.28/250ml

Profile Number 20
Card ID
Milk Type
20 Regular

Packaging
Usage
Pouch
All
Purpose

Price
Rs.28/250ml

You might also like