In Spanish. Translations:
Nombre = First Name
Apellido = Last Name
Dirección = Address
Dirección 2 = Address Continued
Ciudad = City
Estado = State
Teléfono = Telephone
Correo Electrónico = Email
Fecha de Nacimiento = Birthdate
Estado Civil = Marital Status
Sexo = Sex
In case anyone wanted a translation of the survey questions:
1. How many times in the last 6 months have you purchased these [...]