How Many Pints Do You Need?
*
1
2
3
4
5
6
7
More Than 7
How Many Time a Week Do You Want Milk Delivering?
*
1
2
3
4
5
6
7
Do You Want Bread?
*
YES
NO
Do You Want Cheese?
*
YES
NO
Do You Want Butter?
*
YES
NO
Your Name
*
Your Telephone
*
Address 1
*
Postcode
*
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