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Customer Contact Preferences Survey

Dear Sir or Madam, please take a few minutes of your time to complete the following questionnaire.

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1

What is your name?

Please provide your full name.
2

What is your preferred method of contact?

Please select your preferred method of contact.
3

Please provide your preferred shipping address.

Please select either Home or School for the shipping address.
4

Please provide your personal phone number.

Please provide a valid phone number.
5

Please provide your preferred email address.

Please provide a valid email address.
6

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8

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9

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10

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