Please fill in all required fields. If it is not possible for you to send the form (the wheel turns continuously when sending), please send us screenshots of the form by email.
Your test date is within the next 14 days (required field):
I explicitly agree that the test should be started within the next 14 days. If I order express processing, my right of withdrawal will expire with immediate effect. If I do not order express processing, I will lose my right of withdrawal before the end of the withdrawal period of 14 days when the contract is completely fulfilled by LOYALTY TESTER.
—Please choose an option—YesNo
Name, First name (required field)
Street address (required field)
ZIP, City (required field)
Country (required field)
You will not receive any letters from us. You will receive all information, such as the order confirmation and the test protocol, exclusively by email. Please enter an email address to which the test person does not have access. If necessary, set up a free e-mail address, e.g. at Gmail
Your Email address (required field)
best time for callback
In which city should the research be carried out? (required field)
—Please choose an option—femalemale
Please send us separately a current picture of the test person for identification to firstname.lastname@example.org