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Please take a few moments to fill out this confidential questionnaire. The information provided by you will not be shared with anyone. Please make sure that none of the required fields are left blank.





Your First Name (required)

Your Last/Sir Name (required)

Your City (required)

Your State or Province (required)

Your Country (required)

Your Email (required)

Best Contact Phone Number (required)

Best Time To Contact You (optional)

Best Contact Method (required)

Your Age (required)

Your Height (required)

Your Weight (required)

Your Education (required)

Your Marital Status (required)

If Separated, Divorced, Or Widowed, How Long (optional – recommended)

Your Occupation (optional)

Are You Self Employed (optional)
YesNo

Your Income (required)

Describe Your Assets (optional – recommended)

Describe Your Lifestyle (optional – recommended)

Important Things To Know About You (optional – recommended)

Information About The Woman You Seek

Age Range

General Attractiveness

Her Education

Has Children
YesNoDoes Not Matter

What is the most important consideration about the person you want to meet

Additional Comments

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