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| What is your date of birth? |
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| In the last 24 months what phone(s) have you had? (tick all that apply) |
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| How often would you say you use the following:
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| Please choose your favourite design: |
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| Please select your current phone charging device. |
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| How often do you charge your phone or tablet? |
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| What do you think of your current charging method? |
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| How willing are you to give up your current charging method to upgrade to a banana head wireless charger?
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| If you are interested in purchasing a banana head wireless charging station for yourself please fill out your contact information below and we will contact you within 2 days.
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