Chafing Gel Samples On-Line Questions

Thank you for inquiring about a sample of Lanacane Anit-Chafing Gel. As part of our continuous programme of product improvement, we would appreciate the opportunity to understand more about you and how you found out about our product. Please answer the few short questions below and we will send out your discrete free sample immediately. Limit: One sample per family - while stocks last.

How did you first learn about Lanacane Anti-Chafing Gel? (Only one answer)
What specific condition are you interested in Lanacane Anti-Chafing Gel for (if none, skip to question 4)?
Where do you usually experience chafing:
Prior to today, had you tried products to help prevent and relieve chafing?
Yes No
If you answered "Yes" to question 4, what products have you used?
How often would you say you typically experience chafing?
Which of the following age groups do you fall into?
Are you…

Please indicate your dress size (women) or waist size (men)

Male	Waist Size
Female	Dress Size

What was the last grade of school you completed?
What is your household income:

Contact Information

Name:
Address:
State:		Post Code:
Telephone Number:
Email Address:

Please Note: Combe Asia-Pacific Pty Ltd uses the information provided solely for its research related to the Lanacane business. The data provided may be used to evaluate consumers’ responses to our product developments. It may also be used for further research projects. No information will be disclosed to other parties.