Refresh Survey
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1. Refresh Survey

 
Please take a moment to fill out a brief survey.

For participating in this survey, you will be entered into a weekly drawing for a Pepsi Refresh T-Shirt.

Bernick's will periodically send product news, special offers, and award random prizes to participants of this survey.

This survey is completely optional.

Thanks again and have a great Pepsi day!

1. Full Name:

2. Address:

3. City:

4. State:

5. Zip:

6. Beverage you purchase most often? (Choose up to 3)

7. Do you prefer?

8. How often do you purchase the beverage(s) you listed?

9. Package you purchase most often? (Choose all that apply.)

10. Do you use coupons?

11. Would you buy another beverage brand because of price?

12. What is your age?

13. What is your gender?

14. TXT Messaging Number:

15. Email Address:

16. Are you interested in receiving information on: (check all that apply)

17. Additional Comments.