I am not too sure where to put this...

Anyways, I want to create a user experience form where a user of our product could tell me how the product helped them in anyway...

I wanted to keep the form as short as possible so that it does not look like too much of a pain but also getting as much valuable information as I can.

The fields that would be required: Name, email, company, job title, check box for can we contact you, phone number,

What else?

Now as an incentive, I was thinking of an iPod Nano give away every 6 months. Good idea? Bad idea? What other incentives could I give?

Has anyone else ever tried anything like this? If so, how did it turn out?

Thanks for comments.