May we email you with Kit-Cat News, special offers or discounts?   Yes     No

Would you like to receive positive, uplifting and funny emails from Kit-Cat
from time to time?    Yes     No

*Are you at least 17 years of age?    Yes     No

*If no, I have my parent's permission to fill out this form.    Yes     No

Parent/Guardian's Email
(Parent/Guardian will have a notification by email)

Male     Female

Age

Single     Married     No. of Children

Are you a Member of the Kit-Cat Fan Club?    Yes     No

Are you interested in receiving more information about becoming
a member?    Yes     No

Do you now or have you ever owned a Kit-Cat Klock?    Yes     No

When was your first Kit-Cat Klock purchased? 01 02 03 04 05 06 07 08 09 10 11 12 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 15 14 13 12 11 10 09 08 07 06 05 04 03 02 01 00 99 98 97 96 95 94 93 92 91 90 89 88 87 86 85 84 83 82 81 80 79 78 77 76 75 74 73 72 71 70 69 68 67 66 65 64 63 62 61 60 59 58 57 56 55 54 53 52 51 50 49 48 47 46 45 44 43 42 41 40 39 38 37 36 35 34 33 32 31 30

Has anyone else in your family owned a Kit-Cat Klock?    Yes     No

Relation to you

How many Kit-Cat Klocks do you own?

Have you purchased any products or services on line in the
past year?    Yes     No

Past 30 days?    Yes     No