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* 1. First & Last Name 

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* 2. Mailing Address

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* 3. Would you like to be included in our monthly specials & promotions newsletter?

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* 4. Have you ever used Scentsy products before?

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* 5. What type of scents are you typically drawn to?

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* 6. Are you interested in learning more about starting your own Scentsy business?

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