Survey Market Study

Name (Optional):

Age:

Status:

Allowance/sallary per month:

Check as many boxes as you prefer.

Do you wear glasses? [ ] Yes [ ] No

If yes, for what reason:[ ] Fashion

[ ] Eye defect

[ ]Protection from sun

[ ] Reading purposes

[ ] others, specify

______________

Do you wear glasses at night?[ ] Yes [ ] No

Do you encounter problems wearing glasses at night?

[ ] Always

[ ] Sometimes

[ ] Often

[ ] Never

Have you ever heard of glasses with night vision? [ ] Yes [ ] No

If you want to purchase, how much are you willing to spend for the product?

[ ] below 1000

[ ] 1000-1,500

[ ] 1,501-2,000

[ ] 2,001-3,000

[ ] 2,5001 above

How do you want the glasses to look like:

* According to size of lense

* According to the shape of the lens

* According to the shade of the lens

[ ] Tinted [ ] Transparent

* According to the design of the frame

[ ] Printed [ ] Plain

Rate the degree of your preference from 5-1, 5 being the highest.

According to:

Color of the frame

____Black ____Yellow

____White ____Green

____Blue ____Brown

____Red ____Violet

Others, Specify___________

Place of purchase

____Botiques in Malls

____Optical store

____Online shops

____Department Store

____Personal selling

Others, specify__________

Style of packaging

____container

____Box

____Pouch

____Key chain style

Others, Specify_______

Are you interested wearing glasses with night vision?

[ ] Yes [ ] No

Please indicate your opinion on the following statement. Check the box.

Why are you interested to buy?

| Strongly agree | Agree | Indifferent | Disagree | Strongly Disagree |

It is a new innovation. | | | | | |

It is useful. | |...