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First Name:
Last Name:
Address #1:
Address #2:
City:
State:
Zip:
Email:
Phone:
Location:
Price:
Date:
Reason for Return:
Other Sweetener(s):
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First Name
*
Last Name
*
Address 1
*
Address 2
City
*
State
*
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Retailer name where product purchased
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Purchase Price
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Purchase Date
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Reason for Return
*
Select One
Taste
Price
Product Performance
Other
Please describe reason for return.
*
Which of the following sweeteners do you regularly purchase? (Check all that apply)
*
Splenda
Stevia in the Raw
Equal
Lakanto
Private Label
Honey
Sweet N Low
Pure Via
Agave
Sugar
Other
Not Applicable
Where did you hear about the Love It or Your Money Back program?
*
Select One
Truvia.com
Retailer Website
Social Media
In Store Signage
On Package
Other
Please describe referral.
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