We appreciate the time and effort you are dedicating to us and we are thrilled to have
you participate in the Samiah story. All information is confidential and will be used only
by Samiah Clothing to better suit the needs of our customers. Feel free to offer as much or
as little information as you like.

Thank you.

Name:
Street Address:
City, State, Zip:
Phone Number (+ zip code)
Email:
Web site:
Profession:
 
Would you like to be added to our mailing list?
Yes No Already on list
 
How did you hear about Samiah or Samiah.com?
What Samiah fashion pieces do you own?
Where do you wear Samiah designs?
What do you want to see next?
In one word, how does it make you feel when you wear a Samiah fashion piece?
How would you describe your experience wearing a Samiah fashion piece?
How does your Samiah fashion piece(s) reflect on your personal style?
Where would you like to see our clothes sold near you: (please name the boutique and location,)
Where do you live?
Big city Suburbs Town Country


What age group are you?

15-24 Lad/Maiden 25-34 Lord/Lady 35-44 Baron/Baroness
45-54 Duke/Duchess 55-64 King/Queen 65+ Marquis/Marquess


Would your daughter or mother wear one of your Samiah fashion pieces?
What magazines do you read?
What are your favorite movies of all time?
What are your favorite tv shows?

How often are you on the internet?
Often Occasionally Seldom


Do you order clothing online?
Often Occasionally Seldom Never


What are your concerns in ordering clothing online?
What improvements do you think Samiah can make to provide better products and services to you?
Any comments you would like to make?