Lotus Cigar Cutter Questionnaire

Lotus Cigar Cutter Questionnaire

Please fill in the information below to receive a free pouch for your Lotus cigar cutter from Integral Logistics. Please allow 6-8 weeks for delivery.

*Please note that this questionnaire is for Customers only; it is not for retailers. Retailers please use this link.

Date of Purchase / MM / DD YYYY
Place Purchased
Product Name/Number CUT100 CUT200 CUT300
Color Black Chrome Gunmetal
What Brand(s) of lighter(s) do you currently own? Bugatti Colibri Disposable Firebird Lotus Porsche
Prometheus Solo Titan Vertigo Xikar Other I don't own a lighter
If you selected Other (above) - Please enter brand:
What are your favorite lighter features? The overall look of the lighter The finish on the surface of the lighter Cigar features like built-in punches and cutters Windproof/Wind resistant flame Multiple flames Colored Flames Large flame adjustor
Reason for Purchase Self Gift
Price $ . Dollars Cents
Name First Last
Sex M F
Age Group 18-25 26-35 36-45 46-55 56-65 over 65
Address
Street Address

Address Line 2

City

State / Province / Region

Postal / Zip Code

Country
Phone - (###) - ### ####
Email
UPC # (located on back of box)

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