Questionnaire

 　

　Before filling out the questionnaire, please read the notes.　　

　　　　We would like you to fill out the questionnaire below if time permits.

　　　　One of the respondents will get a discount coupon for our services.

　　　　The fortunate respondent is selected once a month by lot.

　　　　You can answer the questionnaire only one time every month.

　　　　Please fill out all the questionnaire, or your name will be dropped 

　　　　from the list of the candidates who may get the discount coupon.

　　　　If you are selected fortunately, you will know that by the arrival of the coupon.

          　　　

　Questionnaire　

　　　　Please fill out whole blunks below without fail.


■ Questionnaire
Name
E-mail address
Postal code number
Address
Phone number
Sex female male
Birth date yearmonthday
Occupation
Internet experience 1 year 2 years 3 years or more
PC you use Windows Macintosh other
Please comment 

on our website

 ■I am satisfied with the contents of our homepage

　　1.　very much
　　2.　moderately
　　3.　not
　　4.　not at all

■I am satisfied with the designs in the web site

　　1.　very much
　　2.　moderately
　　3.　not
　　4.　not at all

■I am satisfied with the readability of the contents

　　1.　very much
　　2.　moderately
　　3.　not
　　4.　not at all

■I am interested in (multi-selection allowed )

　　Fashion
　　Sports
　　Health and medicine
　　Living and culture
　　Music and art
How did you access to our homepage? (ex: search engine)

Let us know your opinion or impression about us.