Stremick's Heritage Foods

Please fill out the form below to receive your e-coupon for $1.00 off any two half gallons of Stremicks Heritage Foods Little Einsteins Milk. Please note that your personal information will never be shared with any other party or organization. After submitting the form you will be taken to an instructional page—please follow these instructions carefully in order to print your e-coupon properly. Enjoy your savings…and your fresh, great tasting milk.

Registration Fields:

First Name:
Last Name:
Address:
City:
State:
Zip:
Phone Number:
E-mail Address:
Confirm E-mail Address:

Have you previously purchased organic milk?	YesNo
If so, which organic brand did you purchase?	Stremicks Heritage Foods Horizon Organic Valley Store Brand Other(Please Specify)
How many individuals consume milk in your household?	1 person 2-3 people 4+ people
Do you purchase other organic products?	YesNo
Age:	20-34 years 35-54 years 55+ years
What is your household income?	$35,000-$49,999 $50,000-$74,999 $75,000-$99,999 100,000
Are you the primary grocery shopper?	YesNo

Would you be interested in receiving further offers and information about Stremicks Heritage Foods Organic Milk?

YesNo

4002 Westminster Ave., Santa Ana, Ca 92703, Phone: (714)775-5000, Fax: (714)775-7677, email: info@heritage-foods.com

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