* 1. What is your first name?

* 2. What is your last name?

* 3. What is your email address?

* 4. What is your phone number?

* 5. When did you last purchase Chinese Laundry Shoes?

* 6. From what retailer or website did you buy your last pair of Chinese Laundry shoes?

* 7. Drag and drop the following in importance to you when making a shoe purchase (1 = Most Important, 4 = Least Important)

* 8. From what store(s) or website(s) do you most often purchase shoes?

* 9. How often do you purchase shoes per year?

* 10. I would purchase more from Chinese Laundry if:

* 12. Yes, please send news of exclusive promotions and new arrivals to me.

T