Questionnaire

Thank you so much for taking the time to fill out our optional questionnaire. Please be assured that we do not distribute and/or sell the email addresses to anyone. This form is strictly to see if there are any additional ways to meet the needs of our customers! To maintain confidentiality, we will only list your first name, your state, and the bracelet style you purchased. Thanks again!

Your Name:
Your Email Address:
State:
How You Heard About Us:	Please Select Friend Family Previous Customer Google Search MSN Search AOL Search Yahoo Search Other Search Engine Another Website
Referred To Our Website By:
Something New You Would Like To See On Our Site (please be specific):
Additional Comments:
Would You Like To Receive an Email About Anything New On Our Site:	Please Select Yes No
Ok To Display Your Comments On Our Testimonials Page:	Please Select Yes No

Miracle Beads, LLC
455 Cross Creek Drive
Huntingtown, Maryland 20639

(443)624-0967
Email us at: info@miraclebeadsllc.com

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