| First name: | |
| Last name: | |
| Address 1: | |
| Address 2: | |
| City: | |
| State: | |
| Zip: | |
| Country: | |
1. Do you, or anyone in your household, drive a car? | Yes No |
| (If you answered "no" to the question above, please skip to question 7) |
2. What brand car do you drive?
Make:
Model:
Year: |
|
| 3. How often do you drive your car? | Rarely
Once a week
Several times a week
Daily
Several times a day
I drive on the job |
4. What do you think is the most important feature in an automobile?
| Comfort
Safety
Performance
Looks
Good Value / Price |
| 5. Have you, or anyone in your household been involved in an automobile accident in the last three years? | Yes No |
| 6. Considering the vehicle you or someone in your household currently drives, would you say that this vehicle is safe? | Yes No |
| 7. On a scale of 1 to 5, how would you rate the importance of safety in a vehicle for you or your family? | 1 - Not Important
2 - Somewhat Important
3 - Important
4 - Extremely Important
5 - My top concern |
| 8. Would you be interested in purchasing a vehicle equipped with a new type of safety device? | Yes No |
| 9. What is your opinion of the term "Active Safety System"? | Dislike
No Opinion
Like |
| 10. Would you pay more for a car equipped with an "Active Safety System" than for one without? | Yes No |
Thank you for completing the survey!
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