This market research survey template gives product, brand, and consumer insight teams a ready-made paper form for gathering audience data in person. It works well for shopper intercepts, in-store studies, panel recruitment, and field research where respondents fill out a form by hand. The template runs 22 questions across three printed pages.
What this survey measures
The form opens with a demographics section that captures gender, age band, household income, and education level, giving you the profile variables needed to segment your results. A shopping habits section asks how often and where respondents buy, how they first heard about the product, and how important price, quality, reviews, packaging, and other factors are to them. A brands section measures awareness, the brand bought most often, satisfaction, openness to new brands, and price ceiling, and three choice tasks show which trade-offs between brand, price, size, and rating win. Two open questions close the form, so you can connect audience characteristics to awareness and purchase drivers.
How to use it on paper
Print the survey and hand it out at store entrances, trade shows, focus group sessions, or as part of a mailed panel study. Ask each respondent to use a blue or black pen and mark one box per single choice question or several boxes where multiple answers apply. Collect the completed forms, then scan or photograph them and upload the images to PaperSurvey, which reads the marks automatically and compiles your results without manual data entry.
Customize this template
Most teams swap in their own logo, replace the example brand names with the brands in their category, and adjust the income and education bands for their market. You can add screening questions, extend the demographics, or remove sections you do not need, and the layout reflows automatically to fit.
Preview the PDF above, or use this template to start collecting responses today.