Don't hesitate, fill out the Questionnaire today and you're on your way!
All information on this form will be kept strictly confidential.
Describe the person you would like to meet.
Gender:
Male
Female
Preferred Age:
From:
To:
Smoker:
Yes
No
No Preference
Height:
From:
2
3
4
5
6
7
ft.
0
1
2
3
4
5
6
7
8
9
10
11
in. To:
2
3
4
5
6
7
ft.
0
1
2
3
4
5
6
7
8
9
10
11
in.
Appearance:
Very Attractive
Attractive
Average
No Preference
Athletic/activity interests:
Education:
No Preference
High School
Some College
College Degree
Masters
PHD
Marital Status:
No Preference
Single
Divorced
Widowed
Separated
With Children:
Yes
No
No Preference
Religion:
No Preference
Hobbies/Interests:
What qualities are you looking for in that someone special?
Information about yourself.
Name:
Address:
City:
State:
Zip:
Home Phone:
-
-
Cell Phone:
-
-
Work Phone:
-
-
Email Address:
Best time to reach you:
Gender:
Male
Female
Age:
Height:
2
3
4
5
6
7
ft.
0
1
2
3
4
5
6
7
8
9
10
11
in.
Weight:
lbs.
Religion:
Education:
High School
Some College
College Degree
Masters
PHD
Current Occupation:
How Long:
Annual Income:
Under 15K
15K to 25K
25K to 35K
35K to 50K
50K to 100K
100K plus
Interests/Hobbies:
Marital Status:
Single
Divorced
Widowed
Separated
Children:
Yes
No
What ways have you used in the past to meet people?
What makes it difficult for you to meet other singles?
How long have you been thinking about a new way to meet people?
Interested In:
Casual Dating
A Long Term Relationship
Marriage
What encouraged you to fill out this questionnaire?
How did you find our website?
1210 N. Argonne Rd. Suite C, Spokane, WA 99212
