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First Name
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Last Name
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Address 1
Address 2
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City
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State
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Postal Code
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Email Address
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What is your favorite e-cig brand?
e Cig Inc
Advantage
Blu cigs
Cloud 9
e Smoke
Eluma
Green Smoke
Lux
Njoy
Premium
Smoke Tip
Smokeless
South Beach
The Safe Cig
v2cigs
White Cloud
Other
If Other Brand - What Brand?
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What is your favorite Nicotine Strength?
0mg
6mg
11mg
16mg
24mg
Not Sure
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What is your favorite Flavor
?
Reg. Tobacco
Apple
Cappuccino
Chocolate
Coffee
Espresso
Menthol
Vanilla
Other
If Other - What Flavor?
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Where do you normally buy your e-cigs?
Gas/C-Store
Mall
Night Club
Online
Please rank ( 1 thu 4 ) what you find most appealing about e-cigs
Healthier than tobacco cigarettes
Can help you cut down or quit smoking
Can use in most non smoking areas
No second hand smoke
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