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How often do you conduct surveys?
 
Weekly
 
Monthly
 
Quarterly
 
Annually
 
 
 
What types of credit cards do you have (Select all that apply)?
 
Visa
 
Mastercard
 
American Express
 
Discover
 
Diners Club

 
 
 
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Customer Service
Product Packaging
On-Time Arrival
 
 
 
First Name : 
Last Name : 
Address 1 : 
Address 2 : 
City : 
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Email Address : 
 
 
 
What is your date of birth?
 
 
 
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