DEAR MR. / MRS.

,_________________________________

Today we are conducting a survey to find out the consumption habits of

coffee and the profile of the consumer, we ask you to answer the different
questions, it will help us obtain the best results.

GENDER
Female ( )

Male ( )

AGE
(__________________)

OCCUPATION
Study ( )
Works ( )
Independent ( )
Others ( )

MARITAL STATUS
Married ( )
Single ( )
Widower ( )
Separated ( )

DRINK COFFEE

Yes ( )
Do not ( )
WHERE DO YOU BUY THE COFFEE
Supermarket ( )
Coffee shop ( )
Restaurants ( )
Others ()

WHAT KIND OF COFFEE DO YOU USE AND WHY?

Instant coffee ( )
Coffee beans ( )
Ground coffe ( )

IN WHAT KIND OF PRESENTATION OR PACKAGE DO YOU BUY

On ( )
Bag( )
Aluminized bag ( )

KNOW WHAT IS THE ORIGIN OF THE COFFEE YOU CONSUME

National ( )
Imported ( )
Does not know ( )

AT WHAT TIMES OF THE DAY DO YOU DRINK COFFEE

_______________________________________________________________
_______________________________________________________________

HOW MANY CUPS OF COFFEE YOU CONSUME PER DAY

I do not consume
1 cup ( )
2 cups ( )
3 cups ( )
4 cups ( )
more than 4 ( )

ACCOMPANY YOUR FOOD WITH COFFEE

Yes ( )
Do not ( )