First Name

Last Name

Email

Phone

How often do you order cigars online?

Once a week
Once a month
Once every two months
Very often - more than 8 times a year

How did you hear about Dignity?

Word of mouth
Event
Internet
Magazine

What Dignity Cigar do you enjoy?

Black Gold
White Gold
Gold
I enjoy all the blends

Please tell us the cigar retailer(s) where you purchased Dignity.

Please give us the name of the cigar lounge or tobacconist near you?

What cigar sizes do you like most?

Robusto
Torpedo
Churchill
Corona
Toro
Petit Robusto
Lancero

Do you like big ring gages above 52 +

Yes
No

What gage would you like to see?

54 x 6
56 x 6
58 x 6
60 x 6
62 x 4
62 x 5
62 x 6

Street Address:

City:

State:

Zip:

Which of the following exclusive Dignity Cigar Club Specials would interest you?

Buy 1 box, get a free 3 - pack
Buy 2 boxes, get a free 10 - pack
Buy 3 boxes, get 1 box free
Buy 4 boxes, get 1 box free plus a Hat & T-shirt
Buy 3 Pack Robusto Sampler
Buy 3 Pack Torpedo Sampler
Buy 5 Pack Churchill / Obese Sampler

What is your T-Shirt size?

Small
Medium
Large
XL
XXL
XXXL

Who referred you to join the Dignity Cigar club?