Urbanez Survey Form

Urbanez Form

Personal Particular

Name:

Age:

E-Mail:

H/P:

Profession:

Position:

Income Level:

FeedBacks/ Suggestions

Have you tried shopping online? Why?

How often do you shop online on average?

Less than 2 times a week
More than 2 times but less than 5 times a week
More than 5 times a week

Would you like to receive information on promotions, discounts and events through the internet?

Yes No

If yes, Which genre of information are you interested to know about?

Pubs, Clubs, Cafes, Wine & Dine, Chillouts
Fashion
Travel
Business & Misc