Date
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Month
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Day
Year
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First Name
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Last Name
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E-mail
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What do you mostly shop for?
Grocery
Meat
Produce
Liquor
Tortilleria
Bakery
Cremeria
La Perla Brand
Mexican Kitchen
Which Store Location do you shop?
Riverbank
Turlock
Hughson
Crows Landing-Modesto
Mitchell Rd.-Modesto
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