Please complete our official "Coffee Connoisseur Registry" form to become an honorary member of our distinctive registry, which entitles you to receive our free newsletter, promotional e-mails and offers and future events information. Thank you.

Please note. All fields marked with an asterisks (*) are required.
I. Contact Information
First Name *
Last Name *
Email *
Phone Number *
 -   - 
United States Addresses Only
Address *
Address
City *                 State *        Zip *
     
International Addresses Only
International Address *
International Address
County/Province/State *
Town/City *
Postal Code *
Country *
II. Personal Information
1. Gender *
Female
Male
3. Age Group *
Under 25
25-34
35-44
45-54
55-64
Over 65
5. Occupation *
2. Level of Education *
High School
College
Graduate
Post Graduate
4. Annual Income *
Below $25000
$25000-$50000
$50000-$75000
Above $100000
III. Interests
6. What is your favorite hobby? *
7. What is your favorite sport? *
8. What is your favorite magazine? *
9. How did you hear about Ospina Coffee? *
At a Store
News Article
Magazine Ad
Internet Search
Internet Ad
Coffee Website
From a Friend
Other
IV. Coffee Preferences
10. How do you prefer your Coffee? *
Regular
Decaf
Flavored
12. How do you prefer the roast? *
Light
Medium
Dark
Espresso
14. Where do you prefer to buy your fresh coffee? *
Department Store
Grocery Store
Delicatessen
Specialty Shop
Direct from Roaster
Internet/Online
16. What is your favorite brand of coffee? *
11. How do you buy your coffee? *
Whole Beans
Ground
Instant
13. How do you brew your coffee? *
Auto Drip
French Press
Espresso
Vacuum Method
15. Which is your favorite coffee origin? *
Colombia
Hawaii
Costa Rica
Ethiopia
Indonesia
Jamaica
Guatemala
Kenya
Other
V. A Few Questions
17. Have you ever ordered fresh coffee through the Internet (Online)? *
Yes
No
18. Have you tasted OSPINA ESTATE COFFEE, the World's Elite Coffee? *
Yes
No
19. Would you like to receive more information, news, promotions and special offers from Ospina Coffee Company? *
Yes
No
VI. Thank You

Ospina Coffee Company, Inc.
3116 Weddington Road
Suite 900, Box 150
Matthews, NC 28105
U. S. A.
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