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Customer

Main Survey:
Page:

Schedule a payment
1. What is your occupation?
Request an inspection
AN: …………………………………..
Contact an you
2. What are agent
using [Item]
for right now?
Report an Issue
AN: …………………………………..
3. What is your main barrier
that stops you from using it?
AN: ……………………………………

Submit
Customer
Profile Survey:
Page:

1. What is your occupation?


Name: ……………………..
AN: …………………………………..
Age: …………………………
2. What are you using [Item]
Gender: ……………………
for right now?
AN: …………………………………..
Occupation: ……………..
3. What is your main barrier
Tel
thatnumber:
stops you ………………
from using it?
AN: ……………………………………

Submit
CustomeranSurvey:
Report Issue:

1. What is your occupation?


What is the issue you’re
AN: …………………………………..
wishing to report?
2. What are you using [Item]
for right
AN: now?
………………………………
AN: …………………………………..
…………………………………….
3. What is your main barrier
…………………………………….
that stops you from using it?
AN: ……………………………………
…………………………………….

Submit
Submit
Customer Survey:
Schedule a payment:

Please
1. What select
is your the date of
occupation?
payment: dd/mm/YY
AN: …………………………………..
2. What are you using [Item]
for rightselect
Please now? a payment
AN: …………………………………..
option: Visa/Debit/Credit
3. What is your main barrier
that stops you from using it?
Please enter the amount
AN: ……………………………………
to be paid: ………………….

Submit
Customer Survey:

1. What is your occupation?


AN: …………………………………..
2. What are you using [Item]
for right now?
AN: …………………………………..
3. What is your main barrier
that stops you from using it?
AN: ……………………………………

Submit

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