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* 1. What is your first and last name?

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* 2. Age:

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* 3. Phone number:

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* 5. When is the last time you tried or purchased vape products?

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* 6. What type of e-vapor or e-cigarette product was it?

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* 7. What brand of e-vapor or e-cigarette was it?

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* 8. What is your regular brand of cigarettes?

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