CONNOISSEUR FORM
There are only 50 spots available to become a part of our foundation.
Name
*
First Name
Last Name
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Would you be willing to help us grow the Brew Samplers Club community by sharing your experience and introducing your friends, family, and coworkers to what we're building?
*
Yes
No
Does your workplace offer complimentary coffee for employees or staff?
Yes
No
Not Sure
If yes, would you be willing to recommend Brew Samplers Club to your employer? If your referral results in a commercial partnership, you'll receive a $100 referral reward.
Yes, I'm willing to share with my employer.
Do you currently drink particular type of coffee? Please name each one. Example under the text box in the Sub label space. (Enter N/A or No if you don't.)
EXAMPLE: Brand Name (Folgers) - Roast name (Colombian) - Pack size (22oz or 6pk)
What roast level do you prefer?
*
Light Roast (smooth & mellow)
Dark Roast (bold & intense)
I enjoy all roast levels
How strong do you like your coffee?
Mild
Medium/Balanced
Strong & Bold
What flavor notes do you enjoy?
*
Nutty
Chocolatey
Fruity
Earthy
Spicy
Floral
Sweet/Caramel-like
Smoky
I’m open to anything
What kind of coffee do you usually drink?
*
Regular (caffeinated)
Decaf
Both (Reg & Decaf)
What type of coffee do you usually buy?
*
K-cups/pods
Grounds
Whole Beans
Instant Coffee
Nespresso capsules
What type of coffee products is your coffee machine compatible with?
*
Grounds
Whole Beans
Whole Beans & Grounds
K-cups/pods
Other
Want to win prizes and exclusive offers by referring us to your friends, family and colleagues?
*
Yes!
Not right now
How did you find this Coffee Survey?
*
Brew Samplers Club Website
Facebook
Google
Public Event
How often do you drink coffee?
*
Daily
A few times a day
A few times a week
Rarely
What size cups do you usually make?
*
Small/Single-serve (Less than 12oz)
Medium (12oz)
Large (12oz+)
Any dietary preferences or restrictions?
*
None
Dairy-free
Lactose-free
Sugar-free
What are your preferred brewing method?
*
Drip
Pour-over
French press
Cold brew
Pod machine
Submit
Should be Empty: