Highway Image Choice Survey
There are some error(s). Please see each marked section below.
Required Question(s)
1.
Please enter the information indicated below where you would like us to send the toll pass cover.
First Name:
Last Name:
Company Name:
Work Phone:
Email Address:
emailaddress@xyz.com
Address 1:
Address 2:
City:
State/Province
(US/Canada):
-- Select a state --
-- Non U.S. --
Alabama
Alaska
Alberta
Arizona
Arkansas
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
British Columbia
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Manitoba
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Brunswick
New Hampshire
New Jersey
New Mexico
New York
Newfoundland and Labrador
North Carolina
North Dakota
Northwest Territories
Nova Scotia
Nunavut
Ohio
Oklahoma
Ontario
Oregon
Pennsylvania
Prince Edward Island
Quebec
Rhode Island
Saskatchewan
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Yukon Territory
Postal Code:
2.
How did you learn of our Highway Image Toll Pass holder?
In the media (newspaper, magazine, trade journal, billboards, etc)
In the media (newspaper, magazine, trade journal, billboards, etc)
Internet media (Blogs, Articles)
Internet media (Blogs, Articles)
Internet search (Google, Yahoo, AOL)
Internet search (Google, Yahoo, AOL)
Membership email
Membership email
Word of mouth
Word of mouth
Visiting as a returning customer
Visiting as a returning customer
Other
Comment:
500 character(s) left.
3.
Please indicate which of the following are most interesting to you.
NFL (National Football League)
NFL (National Football League)
MLB (Major League Baseball)
MLB (Major League Baseball)
NBA (National Basketball League)
NBA (National Basketball League)
NHL (National Hockey League)
NHL (National Hockey League)
Patriotic Flags/Icons
Patriotic Flags/Icons
Comment:
500 character(s) left.
4.
What interested you most in our productr? Select all that apply.
Affinity or desire for the image available (NFL, MLB Team)?
Affinity or desire for the image available (NFL, MLB Team)?
The need for a better looking toll pass?
The need for a better looking toll pass?
Other
5.
Which of our other promotions would interest you? Select all that apply.
Free gas for a month
Free gas for a month
Free tolls for a month
Free tolls for a month
Toll savings credit card
Toll savings credit card
Gas savings credit card
Gas savings credit card
Parking savings credit card
Parking savings credit card
General transportation credit card, (gas, toll, mass transporation, rentals)
General transportation credit card, (gas, toll, mass transporation, rentals)
Comment:
500 character(s) left.
6.
What is your level of satisfaction with our Web Site?
Very satisfied
Very satisfied
Satisfied
Satisfied
Dissatisfied
Dissatisfied
Comment:
500 character(s) left.
7.
How likely are you to refer someone to our site?
Very likely
Very likely
Somewhat likely
Somewhat likely
Neutral
Neutral
Somewhat unlikely
Somewhat unlikely
Very unlikely
Very unlikely
Comment:
500 character(s) left.
8.
Do you have any suggestions for improving our offering?
350 character(s) left.
9.
Thank you! Highway Image would like to send you a toll pass cover at no cost for filling out this survey. Please let us know which image you would like.
American Flag
American Flag
Soccer Ball
Soccer Ball
Winner Checker Flag
Winner Checker Flag
Pirate
Pirate
Other: Please indicate below which image you'd like from our Web site!
Other: Please indicate below which image you'd like from our Web site!
Comment:
500 character(s) left.
2.