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.

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

Select as many options as you would order.

ORA

MINUTO

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

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Video

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Billing Address

* Country

* State/Province

* County

Sub Total

$200.00

TOTAL

$200.00

Payment Method

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	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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