This worksheet is a template for developing your own survey based on the type of product or service your company offers. Please refer to the Sample Brand Loyalty Survey as an example.

1. Please check all types of ____ your business owns in column A, how many in column B, and if your company plans to purchase a type of ____ within the next 12 months in column C.
   

   Types	A	B	C
   	Owns	How Many?	Plans to Purchase?

2. Please check all the makes of ____ listed below that your business owns in column A and the makes of ____  your business plans to purchase in column B.
   

   	A	B		A	B
   Makes	Owns	Plans to Purchase?	Brands	Owns	Plans to Purchase?
   Other: ______________________