Street Address: Postal City code: Zip Code:
Name: Password:
What flavors do you like? Vanilla Strawberry Chocolate
Which is your favorite? Vanilla Strawberry Chocolate
Choose a point on the map: You may submit this request internally: or to the external world: When you are finished, you may submit this request: You may clear the form and start over at any time: Vanilla Strawberry Rum and Raisin Peach and Orange HaL Computer Systems 1315 Dell Avenue Campbell, California 95008
Please fill out this questionnaire:
Your name:
Male
Female
Number in family:
Cities in which you maintain a residence:
Thank you for responding to this questionnaire.