Hannaford Customer Panel

New Member Signup Questionnaire

Thank you for your interest in joining the Hannaford Customer Panel. Please complete the following questions to complete the signup process. This information is for research purposes only and will be held in the strictest confidence. Your privacy is assured.

First Name:

Last Name:

Street Address:

City: State: Zip Code:

Area Code: Phone Number: (e.g.- 123-4567)

E-mail Address: (Primary method of contact)

Confirm E-Mail address:

First Name:
Last Name:
Street Address:
City:	State: Zip Code:
Area Code:	Phone Number: (e.g.- 123-4567)

E-mail Address:	(Primary method of contact)
Confirm E-Mail address: