SALT BOX REGISTRATION & STYLE PROFILE Salt Box Questionnaire Name First Last Last Birthday * Phone Email Address * Address Address 1 Address 1 Address 2 (Suite, Unit/Apt #) Address 2 (Suite, Unit/Apt #) City City State/Province Alabama Alaska Arkansas Arizona California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming State/Province Zip/Postal Zip/Postal Height * Weight * Shirt Size * XS S M L XL XXL How Do You Like Your Shirts to Fit? * Slim (Very Fitted) Contemporary (Slim, but not too fitted) Classic (More Room in the Chest & Waist, Easy Fit) Blazer Size * Shoe Size * Pant Size * Waist x Inseam (Ex. 34Wx32L) How Do You like Your Pants to Fit? * Slim Straight Relaxed Tapered Favorite Brands: * Favorite Styles / Immediate Needs: * Salt Box Subscription * Monthly Quarterly (March, June, Sept, Dec) Budget For Box Delivery * $500 $1,000 $2,500 We discount what you keep. Keep $500 = 5% Discount Keep $1,000 = 10% Discount Keep $2,500 = 20% Discount Start Date for First Salt Box * Additional Comments // Notes // Message: Submit If you are human, leave this field blank.