Demographic and Retail Shopping Survey Template

Demographic and Retail Shopping Survey Template is used to collect demographic and shopping intent information. These questions are also often included in other samples as well. This questionnaire example is typically used as a part of market research survey, which helps identify factors that are unique to a certain demographic and get details about a shopper's profile.



   
 
Within what price range are the daytime dresses you typically purchase?
 
$30.00 or less
 
$30.01 to $50.00
 
$50.01 to $70.00
 
$70.01 to $90.00
 
$90.01 to $110.00
 
$110.01 to $130.00
 
$130.01 to $150.00
 
$150.01 to $170.00
 
$170.01 to $210.00
 
More than $210.00
 
   
 
When shopping for an everyday dress, how many stores do you typically visit?
 
1
 
2
 
3
 
4
 
5
 
6-9
 
10-12
 
More than 12
 
   
 
What is your approximate age?
 
18 - 24
 
25 - 34
 
35 - 44
 
45 - 54
 
55 - 64
 
65 and over
 
   
 
Indicate your marital status.
 
Single
 
Married
 
Widowed
 
Divorced
 
   
 
Please indicate your approximate yearly household income before taxes. (Include total income of all adults living in your household.)
 
Under $25,000
 
$25,001 - $49,999
 
$50,000 - $74,999
 
$75,000 - $99,999
 
$100,000 -$149,999
 
$150,000 and over
 
   
 
What was the last grade you completed in school?
 
Some high school
 
High school graduate
 
Some college
 
College graduate
 
Postgraduate/professional
 
   
 
Please indicate the number of children in your household under the age of 18.
 
None
 
One
 
Two
 
Three
 
Four or more
 
   
 
Including yourself, how many persons are in your household?
 
One
 
Two
 
Three
 
Four
 
Five or more
 
   
 
What is your current work status?
 
Work outside home full time
 
Work outside home part time
 
Do not work outside home
 
   
 
What is the present occupation of the head of household?
 
Professional/technical
 
Manager/official/proprietor
 
Clerical
 
Sales
 
Crafts/trades
 
Operator
 
Laborer
 
Service worker
 
Retired
 
Homemaker
 
Student
 
Unemployed
 
Other
 
 
   
 
Please write in your ZIP Code.
   
 
   
 
Thank you for your participation.
 

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