Feedback

For verification purposes we require you provide all  of the information below that was entered at time of placing your online order, so we may contribute a percentage to the organization that you were referred by.  Please note, we will accept only one survey with each order placed.



Full Name :
Email account used at time of purchase :
Date of purchase :
Total purchase amount :
Special Offers (Purchase $70 or more and receive a free umbrella or t-shirt, Purchase 2 beach towels and get the third for half off )
  Umbrella
            Or
 
T-shirt Gender T-Shirt Sizes Color



HOW DID YOU HEAR ABOUT US?

PLEASE CHECK ONE OF THE BOXES ON THE LEFT NEXT TO THE ORGANIZATION NAME


  Assyrian Universal Alliance
  Christiansofiraq
  Mesopotamian-night
  Assyrian Aid Society
  SAC Assyrians
  Ashur TV
  Assyrian Medical Society
  Mar Addai Church
  Friend
  Surfing the web
  George Tragic
  Other