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1. First name

Last Name

2. Email Address

Phone Number

City

3. Do you use/have you used Palmyra Sugar or Coconut Sugar?

Yes No

If others, please write

5. Would you like to know more ways to include these healthier sugar alternatives in your daily diet?

Yes No

6. Would you be interested in being a Product Tester?

Yes No

7. Would you be interested in our Mini Distributor Program where you can earn and be part of our Innovative food concept and development team?

Yes No

8. Do you think these sugars are good alternatives to replace regular cane sugar?

Yes No

9. Would you like to replace regular sugar with our sugars in your daily routine?

Yes No

10. Do you have a preference?

Coconut Sugar Palmyra Sugar Not Used both

11. If you had to choose one, what would it be?

20% Discount 10% Discount + Free Shipping Flat175 off on purchase value of 800 Flat300 off on purchase value of 1500

ADDRESS

Romaa Paradise, Irulapalayam Road, Chennai – 600124, Tamilnadu, India