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OOicial Questionnaire of
Aqua Thirst Water Refilling
Station
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East Systems Colleges of Rizal
Morong, Rizal
Name (optional): ______________________________________________ Date: ______________________
Address: ________________________________________________________________________________

Dear Customer:
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We, the proponents of Aqua @hirst Water Refilling !tation are "ondu"ting a sur#e$ for us to pro#ide
qualit$ drin%ing &ater and ser#i"es that fit $our needs and &ants' We need $our help in filing up this
questionnaire' We appre"iate $our parti"ipation in this sur#e$ and &el"ome $our feedHa"%'

%
Dire"tion: Ans&er the follo&ing question H$ putting a "he"%mar% ( ) on the HoI pro#ided that "orrespond $our
ans&er'

*' +lease indi"ate $our age range'

" "
*L-./ .0-1/
"
Email
10-0/ "
00 or older
.' +lease indi"ate $our 2ender'
" "
Male 3emale
1' 4o& man$ people are there in $our famil$5
" "
. / 6thers (spe"if$):_____
Did you find this document useful?
"
1 "
0
/' +lease indi"ate $our household in"ome'
" $ $
+L, 777 and Helo& +*0, 77* 8 + 17,777 +07, 77* and higher
$ $
+L, 77* 8 + *0,777 +17, 77* 8 + 07,777
0' Aqua @hirst Water Refilling !tation is "urrentl$ attempting its estaHlishment in 9rg$' Zuisao, +ililla,
Rizal' Whi"h Hest des"riHes $our opinion of these efforts5
" " $
;er$ positi#e < ha#e no opinion ;er$ negati#e
" "
!ome&hat positi#e !ome&hat negati#e
=' Would $ou "onsider patronizing a &ater refilling station if one &ere lo"ated in $our Haranga$5
" "
>es No
Is this content inappropriate? Report this Document
?' @sing the list Helo& &hat fa"toras &ould most influen"e $ou to patronize a &ater refilling station5
" " "
Bo"ation Con#enien"e Cost
" " "
Zualit$ ser#i"es cinds of drin%ing &ater Reputation of &ater station
L' 4o& a&are $ou are regarding the safet$ and "leanliness of &ater $ou drin%5
" " "
;er$ mu"h a&are A&are Not mu"h &are at all
" "
Mu"h a&are Not mu"h &are
d' 3rom &hat sour"e does $our drin%ing &ater "omes from5
" "
+ililla Water Distri"t Deep &ell 6thers (spe"if$): _________
" "
Water pump Water refilling station
*7' 4o& frequentl$ do $ou Hu$ Hottled &ater5
$ $ $
Dail$ 6n"e a &ee% 6n"e a month
$ $
@&i"e a &ee% @&i"e a month
**' What size of Hottled &ater do $ou Hu$ normall$5
$ $ $
117 ml *'0 liters *'0 gal
$ $ $
077 ml 1 liters .'0 gal
$ $ $
* liter * gal 0 gal
*.' 4o& man$ Hottles (117 ml) of &ater do $ou drin% per da$5
$ $
. /
$
1 6thers(spe"if$):_________
*1' <n $our household, ho& man$ Hottles (0gal) of &ater do $ou "onsumed in a &ee%5
$ $
. /
$
1 6thers (spe"if$):____________
*/' Whi"h %ind of &ater do $ou prefer to drin%5
" "
+urified &ater Al%aline &ater
" $
Mineral &ater Distilled &ater
*0' Do $ou alread$ ha#e purified drin%ing &ater dealer5
" "
>es No
<f $es please spe"if$: ________________
*=' Do $ou agree for 17 minutes time span for the deli#er$5
" "
>es No
*?' <f &e offer purified drin%ing &ater, are $ou &illing to tr$5
" "
>es No
*L' Will it He possiHle that $ou "an He our first and lo$al "ustomer5
" "
>es No
*d' 4o& do $ou &ant us to rea"h $ou to ta%e $our order5
$ $ $
@elephoneaMoHile 6nline +ersonal

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