This is for us, to help you, like us not at all. We want to know what pisses you off more than usual.

Realm Of Nimrodia

LEAVE US ALONE SURVEY

The purpose of this survey is to collect information from you about something that piises you off.

This survey is divided into the following sections:

Fill out the information in each section as requested. Then at the end of the form supply your name and contact information, and submit the form. You will receive a confirmation message from us shortly.

Part One-- Miscellaneous

These are the instructions for filling out this section. These are the instructions for filling out this section.These are the instructions for filling out this section.

  1. What would piss you off most?



  2. How many hours of television do you watch per week:

    None 1-5 hours 5-10 hours 10-20 hours More than 20 hours

  3. We would like to send you some literature. What is your mailing address? 
    Name     
Street   
City     
State    
Zip Code
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Part Two-- Odd Stuff

Please fill this out before we piss you off more.

 

  1. How would you rate this survey?

    Bad Poor Fair Good Excellent

  2. What is your favorite color?




  3. Here's another way of collecting address info without using fixed-width text:

    Username
    Password

 

FORM SUBMISSION

Thank you for taking the time to answer the questions in our survey.

This explains how we plan to use the information you provide to us. We will also explain what benefits you receive from helping us in this way.

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Manda for Nimrodia
Copyright © 1999 [Nimrodia]. All rights reserved.
Revised: November 23, 1999.