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Contact Information
First Name:
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City:
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Age:       Gender: Male Female
Phone: (  )   - 
How many cups of coffee, espresso, cappuccino do you drink a day?
1 2 3 4+
How did you find our web site?
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Where did you get your last Kokos Coffee?
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Does this location offer Kokos Coffee Loyalty Cards?
Yes No
Does this location have Kokos Coffee cups?
Yes No
What brand of coffee do you prefer other than Kokos?
  Other:
Yes, I am interested in buying Kokos Coffee's new Signature Collection in 10oz. ground re-sealable retail bags.
Where would you prefer to purchase?
  Other:
Yes, I would like to be on your mailing list to be notified of discounts, promotions and other special announcements.
 
    


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