Survey
Part I. - Quick Fields
Name
*
Prefix
First Name
Middle Name
Last Name
Suffix
Primary e-mail
*
Confirmation Email
No spam
Address
*
Street Address
Street Address Line 2
City
Please Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Phone Number
*
Date
*
/
Month
/
Day
Year
Date Picker Icon
What time is it right now?
*
1
2
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:
Hour
00
01
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Minutes
AM
PM
AM/PM Option
Favorite Number
*
Really, any number is fine
Enter the message as it's shown
*
Part II. - Basic Fields
15 Char limit - any char
*
16 is too many
15 - alphanumeric
*
Numbers and Letters!
How much cash is in your pocket?
If equal to or greater than 1000.00, enter '999.99'
Enter anything into this field.
*
No limits
Enter plain text into this field.
*
No character limits
Enter something if you want to.
Optional
Pick only one
*
Pick one
Option 1
Option 2
Option 3
Just one
You MUST pick one or more
*
Option 1
Option 2
Option 3
More than one
You MAY pick one or more
Option 1
Option 2
Option 3
Optional
You MUST pick one
*
Option 1
Option 2
Option 3
Other
You MAY pick one
Male
Female
N/A
Other
You may NOT pick one
*
Nope
Option 2
Option 3
You MUST pick one or more
*
Option 1
Option 2
Option 3
Other
You MAY pick one or more
Option 1
Option 2
Option 3
Other
You may NOT pick any
*
Option 1
Option 2
Option 3
Upload a random file
Upload a File
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Part III. - Survey Fields
Rate your survey experience so far
*
1
2
3
4
5
Love!
Now rate it on a scale
*
1
2
3
4
5
6
7
8
9
10
Worst
Best
1 is Worst, 10 is Best
I don't know what a spinner is!
*
???
Now submit matrix feedback!
*
Very Satisfied
Satisfied
Somewhat Satisfied
Not Satisfied
Service Quality
Overall Hygiene
Responsiveness
Kindness and Helpfulness
Part IV. - Payment
TEST
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( X )
USD
Do not really pledge money
Part V. - Widgets
Widget Checklist
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