Here, I'll do it for you: http://www.surveymonkey.com/s/PT56NHC
... and now that I've gone to take the survey, I can't finish it because there is no suitable answer for question 6. Another of the questions I had trouble understanding the distinction between "None" and "0" as answers.
So I gave up.
Good surveys are really quite hard to design, and bad surveys are pretty near useless. It's pretty clear you're asking how much people will pay for something you're thinking of producing, so I suggest you think a lot harder about how you're going to get that information. I'll be very surprised if this survey gives you anything reliable.