Media Survey Form

Who should use this Media Survey Form? Everyone in the business of selling products or services!  Think of it this way - you know that it’s very 

important to come up with effective advertising avenues to get your name out there.

So, you’ve tried a variety of sources and are having success getting new customers – great! But what led them to you??

Let’s say 75% of your customers buy your product after seeing a morning television commercial.

If you have this information, now you know how and when to reach your target market!

Using a Media Survey can help you decide where to focus your marketing.

Stop wondering where your efforts are paying off and find out for yourself!

Use this Survey as is, or tweak the questions as needed.


How did you learn of our product?

A. Television Commercial? Yes_______ No________

If "Yes", which channel?______________________

When? Morning_____Afternoon____Evening____Late Night____

B. Radio Spot? Yes________ No________

If "Yes", which station?_______________________

When? Morning_____Afternoon____Evening____Late Night____

C. Newspaper? Yes_________ No_______

If "Yes", which one?____________________________

D. Store Display? Yes_____ No_______

If "Yes", which store?__________________________

E. Other____________________________________________

Related Pages
Cover Letter for Product Literature
Apology for Poor Service Rating on Customer Questionnaire
Invitation to Demo New Product Line

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Exit Media Survey Form - See More Sample Business Letters