Customer Response Form
Cargills (Ceylon) PLC
Title
Mr.
Ms.
Miss
Mrs.
Rev.
Dr.
Prof.
First Name
Last Name
Address 1
Address 2
City
Phone - Residence
Phone - Office
Phone - Mobile
Email
Occupation
Company Name
Birthday
NIC No.
Passport No.
Single
Married
Festivals Celebrated
Wesak
Christmas
Deepavali
Ramazan
Monthly Household Income (LKR)
Below 25,000
25,001 - 75,000
75,001 - 100,000
100,001 - 200,000
Above 200,000
Preferred Language
Sinhala
Tamil
English
Would you like to receive promotional Emails / SMS ?
Yes
No
I agree to submit the above information