Licorice Sugar-Free Pastilles

In our attempt to conduct market research and collect consumer data we have formulated a brief questionnaire and would be greatly appreciative if you have the time to participate.  In our attempt to better reach our customer base through more direct channels and by creating frequent promotions and sampling demos we strive to maintain our customer service at the highest level.  

Because you are helping us to maintain our world class service we would like to offer you a 1-TIME: 5% DISCOUNT on your order upon completion of the questionnaire, and we thank you for your time and participation.

What is your gender?
What is your age?
In which state do you currently reside?
How do you classify the area where you live?
What is your current household income in USD?
How did you originally find out about Licorette?
Would you like to receive future coupons, product discounts via e-mail?
If so, please provide e-mail address
Full Name (*required in order to receive discount)
Complete the questionnaire and get your: