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diff --git a/talersurvey/survey/templates/index.html b/talersurvey/survey/templates/index.html
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+++ b/talersurvey/survey/templates/index.html
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+{% extends "templates/base.html" %}
+
+{% block main %}
+  <div>
+    <p>
+      In this page, you can participate in our survey about payment systems
+      and get a nice tip - via your Taler wallet - from this shop!
+    </p>
+  </div>
+  <div>
+    <form action="{{ url('/survey') }}" method="post">
+      {% if success %}
+        <strong>Congratulations, your reward has been successfully submitted!</strong>
+      {% endif %}
+      What do you prefer?<br>
+      <input type="radio" name="paypref" value="taler">
+        <label>Taler</label>
+      </input>
+      <input type="radio" name="paypref" value="visa">
+        <label>Visa</label>
+      </input><br>
+      <input type="submit" value="Submit"></input>
+    </form>
+  </div>
+{% endblock %}