* 1. Name

* 2. Email

* 3. When did you purchase your Chemistrie Layer?

* 4. Where did you purchase your Chemistrie Layer (Name, City, and State please):

* 6. I heard about Chemistrie from:

* 7. With my purchase I received a complimentary

* 8. How satisfied are you with your Chemistrie Layer?

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* 9. Any other thoughts, comments, or questions are greatly appreciated!

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