Free Marketing Audience Segmentation Questionnaire Template

Marketing Audience Segmentation Questionnaire

Please fill out the form with your information below.

Name

Please enter your full name.

    Date of Birth

    Select your date of birth.

      Email

      Please provide your email address for communication purposes.

        Phone Number

        Enter a contact number where we can reach you.

          Address

          Provide your current address for mailing purposes.

            Preferred Contact Method

            Choose the best way for us to get in touch with you.

              • Phone

              • Email

              • Mail

              Gender

              Please select your gender.

                • Male

                • Female

                • Prefer not to say

                Age Group

                Select your age group from the options.

                  Select your age group18-2425-3435-4445-5455-6465+

                  Occupation

                  Please state your current occupation.

                    Education Level

                    Select your highest level of education.

                      Select your education levelHigh SchoolAssociate DegreeBachelor's DegreeMaster's DegreeDoctorate

                      Household Income

                      Select the range that best describes your annual household income.

                        Select income range<$25,000$25,000-$49,999$50,000-$74,999$75,000-$99,999$100,000-$149,999>$150,000

                        Marital Status

                        Select your current marital status.

                          Select marital statusSingleMarriedDivorcedWidowed

                          Interests

                          Select your interests from the list below.

                            • Technology

                            • Travel

                            • Fashion

                            • Sports

                            • Cooking

                            How did you hear about us?

                            Tell us how you found out about our services.

                              • Online Search

                              • Social Media

                              • Word of Mouth

                              • Advertisement

                              Additional Information

                              Provide any additional comments, notes, etc.

                                Please check the box below to proceed

                                To submit, please verify that you are human.

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