Market Segment Survey Template

12
Questions
Use This Template

Market Segment Survey Template

We'd like to get to know you better and send you more personalized information.

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1.
Your date of birth:
*
2.
What is your gender?
Male
Female
Non-binary
Prefer not to say
*
3.
What is your marital status?
Single
Married
Divorced/Separated
Widowed
*
4.
What is your highest level of education?
High School Diploma
Some College
Associate Degree
Bachelor's Degree
Master's Degree or Above
*
5.
What is your current employment status?
Employed full-time
Employed part-time
Self-employed
Unemployed but looking for work
Retired
Other
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6.
What is your annual household income?
Less than $25,000
$25,000 - $49,999
$50,000 - $74,999
$75,000 - $99,999
$100,000 - $149,999
$150,000 or more
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7.
Are you the primary decision-maker in your household for purchasing goods and services?
Yes
No
*
8.
Which of the following best describes your employment industry?
Education
Healthcare
Finance
Information Technology
Retail
Manufacturing
Other
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9.
Which of the following best describes your occupation?
Manager/Executive
Professional/Technical
Sales
Administrative/Clerical
Service
Skilled Trades
Other
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10.
Which of the following best describes your lifestyle?
Active and outdoorsy
Social and outgoing
Family-oriented
Career-focused
Introverted and reserved
Other
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11.
Which of the following best describes your personality?
Outgoing and energetic
Thoughtful and introverted
Optimistic and positive
Analytical and logical
Creative and imaginative
Other
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12.
Which of the following best describes your shopping habits?
Budget-conscious shopper
Impulsive shopper
Brand loyal shopper
Convenience-oriented shopper
Other
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