Free Pantene Beautiful Lengths Shampoo and Conditioner Sample

Pantene is giving away free samples of Pantene Beautiful Lengths Shampoo and Conditioner. A maximum of 2,000 samples are available weekly for five weeks. U.S. only. Older than 18 years. Limit one per household. LIKE them on facebook, click on "Unete Ya" = "Sign Up Now" circle and fill out the form.
The form is in Spanish:

Nombre = Name
Apellido = Last name
Dirección y Código Postal = Address and Zip Code
Escoge Tu Estado = Choose Your State
Escoge Tu País = Choose Your Country
¿Eres mayor de 18 años? = Are you over 18?
Fecha de Nacimiento (Mes, Día, Año) = Date of Birth (Month, Day, Year)
Correo Electrónico = Email

Thanks Ilovefreebies!