Dear customer,

In our effort to keep this page as up to date and easy to use as possible, we are constantly seeking feedback from our customers. We would like to ask you to enter the following information, and as a special thanks for doing so, you will automatically be entered in our MONTHLY draw to win a discount on your next purchase at http://www.crystalcz.com

We appreciate your time, thought, and suggestions!

First Prize: additional 25% off your next purchase at http://www.crystalcz.com.
 
Second Prize: additional 20% off your next purchase at http://www.crystalcz.com.
   
1. Name:
 2. Address:
3. City:
 4. State:
5. Zip Code:
 6. Country:

Please make sure there are no mistakes in your e-mail address - one small typo and we will not be able to communicate with you about your prize.
7. E-mail Address:
 8. Phone:
.
Do not forget to fill in your user name and password so you can receive your discount when you log in. 
9. User name:
 10. Password


11. Occupation:
 12. Industry:
 
13. Age group: 14. Sex:
   
15. Where did you get our website address?
   
16. How would you rate shopping at our website:
Very EasyEasy Difficult
Very Difficult
   
17. How did you find the assortment at our website:  
Excellent
Very Good
Good		 Fair
Poor
   
18. How likely are you to shop in our e-store again?
Very Likely
Likely		 Uncertain
Unlikely
Very Unlikely
   
19. How likely are you to recommend our e-store to your friends and family?
Very Likely
Likely		 Uncertain
Unlikely
Very Unlikely
   
If you visited our factory outlet store, please rate the following:
20. Quality of service:

Excellent
Very Good
Good
Fair
Poor		 21. Quality of assortment:

Excellent
Very Good
Good
Fair
Poor
   
No, I did not visit your store.
   
Comments:

In our effort to keep this page as up to date and easy to use as possible, we are constantly seeking feedback from our customers. We would like to ask you to enter the following information, and as a special thanks for doing so, you will automatically be entered in our MONTHLY draw to win a discount on your next purchase at http://www.crystalcz.com

We appreciate your time, thought, and suggestions!