KANEKA QH : Official Sweepstakes Entry Form

OFFICIAL SWEEPSTAKES ENTRY FORM

Revive your natural sustained energy with the world’s first
supplemental ubiquinol – KanekaQH™. Enter below for
a chance to win a two-month supply of KanekaQH™.

*Indicates required field

*First name:

*Last name:

*Street Address:

Apt or Suite:

*City:

*Zip:

*Phone (for notification purposes only):

Email:

*CHECK BOX:

I accept official rules (click to view rules)

*Would you like to receive occasional information from Kaneka Nutrients, L.P. regarding CoQ10, Ubiquinol and other supplements?

(Kaneka Nutrients, L.P. will not share or sell your email address with any third parties, and you may opt-out of this list at any time.)

*Date of Birth:

(year)

*How did you hear about this promotion?:

(For Other, Please Specify):

Do you take supplements regularly?

(If Yes, Please Specify):

What supplement benefits are most appealing to you?

Increased Energy

Overall Health and Wellness

Weight Loss and Maintenance

Condition-Specific Benefits (please specify)

Other (please specify)

Have you supplemented with CoQ10 or Ubiquinol before?