Data Survey Form

Last Name

Valid last name is required.

First Name

Valid first name is required.

Title

Valid title is required.

Height(ft)

Valid feet is required.

Inches

Valid inches is required.

Phone Number

Valid number is required.

Address

Valid address is required.

City

Please provide a valid city.

State

Please provide a valid state.

Zip Code

ZIP Code must be 5 digits.

Email address We'll never share your email with anyone else.

Please provide a valid Email.

Phone

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Less than $50

Between $50 and $100

More than $100

I accept the Terms & Conditions

CSC 642 848 Fall 2021 Individual Assignment