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22
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1
Name
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First Name
Last Name
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2
Email
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example@example.com
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3
Address
*
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Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
United States
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Please Select
Please Select
United States
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
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4
Phone Number
*
This field is required.
Please enter a valid phone number.
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5
What Kind Of Scents make Your nose Happy ?
*
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Choose all that apply
Fruit
Masculine or Woodsy
Clean
Spa
Baking
Strong Notes - very heavy
Not strong
Helps with Pet odors
Floral
I do not like my home , car or Office to smell amazing
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6
Have you used Pink Zebra Products Before
*
This field is required.
YES
NO
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7
Have you tried Sprinkles Yet?
*
This field is required.
Non toxic scented wax that you can blend
Yes - I LOVE THEM
No but want to give me a sample
No and not interested
What are sprinkles
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8
Have You used Soaks
*
This field is required.
Liquid fragrance that is skin safe , fabric safe and pet safe
Yes , I love them
No not sure what they are
Yes but not sure what to do with it
No but would like to
Not interested
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9
Have You Tried a Simmering Light Or Simmer Pot?
*
This field is required.
Pink Zebra’s warmers
Yes I have both
No
I am happy with my current warmer
I am not interested in either
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10
Have you Used an Accent Shade
*
This field is required.
Home decor to put over a simmering light
Yes and I am Hooked
No I would like to but it’s too expensive
No and don’t want to
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11
Have You tried any in the Supa Clean Line ?
*
This field is required.
Antibacterial soap, sanitizer, disinfect spray
Yes I love it
No but want to
Nope not interested
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12
Are you a Scentflirt Subscriber
*
This field is required.
Monthly subscription for exclusive products from pink zebra
YES
NO
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13
If you answered No
Go to www.trinacombs.com and sign up if you stay with it 6 months you get a sprinkle discount
No I’m not interested
Message me got questions
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14
Would You Be Interested in Hosting a party to earn free Products?
*
This field is required.
Yes I would Love to
Maybe I need more information
Not interested in this time but can check back
Not interested in this
Yes I would love to Do an in home party
Yes I want to book a Scent Kit event
Yes I want to take up orders and collect rewards
Yes I will do it if it is online party only
Maybe later but I know someone who would
I am not interested but know someone who would love to
Yes I would like to have a online Grab Bag event
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15
I am looking to grow my team! Would you be interested to being part of supportive team!?
*
This field is required.
Check all that apply !
Yes ! I am ready to sign up
Yes , but I want more information or have questions
Yes but I just want it for discount- not interested in selling
Maybe - I want more information or have questions
No but I know someone who is
Not interested but will remain a customer
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16
If you could make payments on starter kit would you ?
*
This field is required.
And join my team ? Check out Klarna they break it into payments intrest Free!! Many use Klarna for orders too
YES
NO
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17
Are You in My Facebook Vip Group Scoop up the Rainbow Vips??
*
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18
What part of the Vip Group do you like the best
*
This field is required.
Check all that apply
Vip Boxes
Sale
Games
ease of payment methods
Meeting new people
I don’t enjoy the group
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19
What type of invoice do you prefer
*
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Check all that apply
Paypal
Square
Email
Facebook pay
Venmo
Zelle
Cash App
Credit card
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20
Would you like an Scent Kit
*
This field is required.
YES
NO
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21
Would you Recommend Pink Zebra and Trina combs to your friends , family Ect ?
*
This field is required.
YES
NO
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22
How happy are you with Pink Zebra ?
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23
Thank you
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