Hand Sanitizer Survey

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* 1. Distillery Name

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* 2. Location

Address

City

State

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* 3. Distillery Phone Number

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* 4. Distillery Website

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* 5. Are you distributing to the public?

Yes

No

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* 6. How should people contact you?

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* 7. Are you selling it or giving it away?

For Sale

Donate

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* 8. What sizes are you making?