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A form which utilizes ALL of the available form fields!

Have fun because they are all required fields!!!

Which of the following foods is your favorite?

Which of the following foods do you prefer.

Hamburger
Salad
Chicken

When is the best time to eat?

Choose an option.

Select

If the following items were on a menu, which would you select?

Select as many options as you would order.

Broccoli
Celeray
Carrots

HOUR

--

MINUTE

--

AM/PM

--

Address

Country

State/Province

Lunch time is the best part of the day because it allows you to eat great food, and energize yourself for the rest of the day.

Billing Address

* Country

* State/Province

Shipping Address

* Country

* State/Province

Family + Friends

Relationship

Add

Remove

To accept this contract, type your name below

Video

File Upload

Browse (no files uploaded)

Billing Address

* Country

* State/Province

* County

Sub Total

$200.00

TOTAL

$200.00

Payment Method

Paypal
Credit Card - Square

Rating Scale

I prefer to eat at home:

Select

I prefer to eat at a sit down restaraunt:

Select

I prefer to eat at a fast food service:

Select

	Strongly Agree	Somewhat Agree	Neither Agree Nor Disagree	Somewhat Disagree	Strongly Disagree
I prefer to eat at home:
I prefer to eat at a sit down restaraunt:
I prefer to eat at a fast food service:

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Column 2

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Radio Description

Choice 1
Choice 2
Choice 3

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