Official Questionnaire of Aqua Thirst Water Refilling Station

East Systems Colleges of Rizal Morong, Rizal Name (optional): ______________________________________________ Date: ______________________ Address: ________________________________________________________________________________ Dear Customer: We, the proponents of Aqua Thirst Water Refilling Station are conducting a survey for us to provide quality drinking water and services that fit your needs and wants. We need your help in filing up this questionnaire. We appreciate your participation in this survey and welcome your feedback. Direction: Answer the following question by putting a checkmark () on the box provided that correspond your answer. 1. Please indicate your age range.  18-24  25-34  35-54  55 or older 2. Please indicate your Gender.  Male  Female 3. How many people are there in your family? 2 4 Others (specify):_____ 3 5 4. Please indicate your household income.  P8, 000 and below  P15, 001 – P 30,000  P50, 001 and higher  P8, 001 – P 15,000  P30, 001 – P 50,000 5. Aqua Thirst Water Refilling Station is currently attempting its establishment in Brgy. Quisao, Pililla, Rizal. Which best describes your opinion of these efforts?  Very positive  I have no opinion  Very negative  Somewhat positive  Somewhat negative 6. Would you consider patronizing a water refilling station if one were located in your barangay?  Yes  No 7. Using the list below what factor/s would most influence you to patronize a water refilling station?  Location  Convenience  Cost  Quality services  Kinds of drinking water  Reputation of water station 8. How aware you are regarding the safety and cleanliness of water you drink?  Very much aware  Aware  Not much ware at all  Much aware  Not much ware 9. From what source does your drinking water comes from?  Pililla Water District  Deep well Others (specify): _________  Water pump  Water refilling station 10. How frequently do you buy bottled water?  Daily  Once a week  Once a month  Twice a week  Twice a month 11. What size of bottled water do you buy normally?  330 ml  1.5 liters  1.5 gal  500 ml  3 liters  2.5 gal  1 liter  1 gal  5 gal 12. How many bottles (330 ml) of water do you drink per day? 2 4 3 Others(specify):_________ 13. In your household, how many bottles (5gal) of water do you consumed in a week? 2 4 3 Others (specify):____________ 14. Which kind of water do you prefer to drink?  Purified water  Alkaline water  Mineral water  Distilled water 15. Do you already have purified drinking water dealer?  Yes  No If yes please specify: ________________ 16. Do you agree for 30 minutes time span for the delivery?  Yes  No 17. If we offer purified drinking water, are you willing to try?  Yes  No 18. Will it be possible that you can be our first and loyal customer?  Yes  No 19. How do you want us to reach you to take your order?  Telephone/Mobile  Online  Personal