[et_pb_section fb_built=”1″ _builder_version=”4.7.7″ _module_preset=”default” da_disable_devices=”off|off|off” da_is_popup=”off” da_exit_intent=”off” da_has_close=”on” da_alt_close=”off” da_dark_close=”off” da_not_modal=”on” da_is_singular=”off” da_with_loader=”off” da_has_shadow=”on”][et_pb_row _builder_version=”4.7.7″ _module_preset=”default”][et_pb_column type=”4_4″ _builder_version=”4.7.7″ _module_preset=”default”][et_pb_text _builder_version=”4.9.4″ _module_preset=”default”]

Enter for your chance at a free item!

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Please answer the questions below so that we can get to know you better. We are only giving away 1 free item a day to 1 lucky individual! Those who take their time to provide detailed answers can see their chance to be chosen grow substantially. By submitting this form you are agreeing to any information you provide being used for marketing and product research purposes. A valid email address that you regularly check and can reply from is required.

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Please be patient.” submit_button_text=”Submit” _builder_version=”4.9.4″ _module_preset=”default”][et_pb_contact_field field_id=”First_Name” field_title=”First Name” _builder_version=”4.9.4″ button_text_size__hover_enabled=”off” button_one_text_size__hover_enabled=”off” button_two_text_size__hover_enabled=”off” button_text_color__hover_enabled=”off” button_one_text_color__hover_enabled=”off” button_two_text_color__hover_enabled=”off” button_border_width__hover_enabled=”off” button_one_border_width__hover_enabled=”off” button_two_border_width__hover_enabled=”off” button_border_color__hover_enabled=”off” button_one_border_color__hover_enabled=”off” button_two_border_color__hover_enabled=”off” button_border_radius__hover_enabled=”off” button_one_border_radius__hover_enabled=”off” button_two_border_radius__hover_enabled=”off” button_letter_spacing__hover_enabled=”off” button_one_letter_spacing__hover_enabled=”off” button_two_letter_spacing__hover_enabled=”off” button_bg_color__hover_enabled=”off” button_one_bg_color__hover_enabled=”off” button_two_bg_color__hover_enabled=”off”][/et_pb_contact_field][et_pb_contact_field field_id=”Last_Name” field_title=”Last Name” _builder_version=”4.9.4″ button_text_size__hover_enabled=”off” button_one_text_size__hover_enabled=”off” button_two_text_size__hover_enabled=”off” button_text_color__hover_enabled=”off” button_one_text_color__hover_enabled=”off” button_two_text_color__hover_enabled=”off” button_border_width__hover_enabled=”off” button_one_border_width__hover_enabled=”off” button_two_border_width__hover_enabled=”off” button_border_color__hover_enabled=”off” button_one_border_color__hover_enabled=”off” button_two_border_color__hover_enabled=”off” button_border_radius__hover_enabled=”off” button_one_border_radius__hover_enabled=”off” button_two_border_radius__hover_enabled=”off” button_letter_spacing__hover_enabled=”off” button_one_letter_spacing__hover_enabled=”off” button_two_letter_spacing__hover_enabled=”off” button_bg_color__hover_enabled=”off” button_one_bg_color__hover_enabled=”off” button_two_bg_color__hover_enabled=”off”][/et_pb_contact_field][et_pb_contact_field field_id=”Email” field_title=”Email Address” field_type=”email” _builder_version=”4.9.4″ button_text_size__hover_enabled=”off” button_one_text_size__hover_enabled=”off” button_two_text_size__hover_enabled=”off” button_text_color__hover_enabled=”off” button_one_text_color__hover_enabled=”off” button_two_text_color__hover_enabled=”off” button_border_width__hover_enabled=”off” button_one_border_width__hover_enabled=”off” button_two_border_width__hover_enabled=”off” button_border_color__hover_enabled=”off” button_one_border_color__hover_enabled=”off” button_two_border_color__hover_enabled=”off” button_border_radius__hover_enabled=”off” button_one_border_radius__hover_enabled=”off” button_two_border_radius__hover_enabled=”off” button_letter_spacing__hover_enabled=”off” button_one_letter_spacing__hover_enabled=”off” button_two_letter_spacing__hover_enabled=”off” button_bg_color__hover_enabled=”off” button_one_bg_color__hover_enabled=”off” button_two_bg_color__hover_enabled=”off”][/et_pb_contact_field][et_pb_contact_field field_id=”Phone” field_title=”Phone” _builder_version=”4.9.4″ _module_preset=”default”][/et_pb_contact_field][et_pb_contact_field field_id=”Free_Product_Preference” field_title=”If you had to choose one product to receive for a free sample, which would you choose?” field_type=”radio” radio_options=”%91{%22value%22:%22Freeze Roll On Cream%22,%22checked%22:0,%22dragID%22:-1},{%22value%22:%2225mg Full Spectrum Gummies%22,%22checked%22:0,%22dragID%22:0},{%22value%22:%22Supreme Focus Mushroom Gummies%22,%22checked%22:0,%22dragID%22:6}%93″ _builder_version=”4.9.4″ _module_preset=”default”][/et_pb_contact_field][et_pb_contact_field field_id=”used_cbd” field_title=”Have you ever used CBD products?” field_type=”radio” radio_options=”%91{%22value%22:%22Yes%22,%22checked%22:0,%22dragID%22:-1},{%22value%22:%22No%22,%22checked%22:0,%22dragID%22:0}%93″ fullwidth_field=”on” _builder_version=”4.9.4″ _module_preset=”default”][/et_pb_contact_field][et_pb_contact_field field_id=”helped_cbd” field_title=”If yes, can you tell us how CBD products have helped you?” field_type=”text” required_mark=”off” fullwidth_field=”on” _builder_version=”4.9.4″ _module_preset=”default”][/et_pb_contact_field][et_pb_contact_field field_id=”brand_cbd” field_title=”If yes, what brands have you used and where did you purchase them (ex: Online or Store)? ” field_type=”text” required_mark=”off” fullwidth_field=”on” _builder_version=”4.9.4″ _module_preset=”default”][/et_pb_contact_field][et_pb_contact_field field_id=”pain” field_title=”Do you suffer from pain? If so, please tell us about it.” field_type=”text” fullwidth_field=”on” _builder_version=”4.9.4″ _module_preset=”default”][/et_pb_contact_field][/et_pb_contact_form][et_pb_code _builder_version=”4.9.4″ _module_preset=”default”][/et_pb_code][/et_pb_column][/et_pb_row][/et_pb_section]