Tell Us About Yourself:
Legal Name:
Preferred Name:
Home Address:
City, State, Zip:
Phone:
Email Address:
Occupation:
Employer:
Marital Status: Never Married Separated Divorced Widowed
If married, how many times:
If married, for how many years:
Do you have any children? Yes No
How Many?
Ages:
Do you desire more children? Yes No Maybe
Your Age:
Birthdate:
Eye Color:
Hair Color:
Height:
Weight:
Where were you born and raised?
Education Level:
School(s) & Degree(s):
Your Race: Caucasian Asian Latino Indian African American Middle Eastern Other Other:
Your Religion: Agnostic Atheist Buddhist Catholic Christian Not Religious Jewish Spiritual Other Other:
Describe Your Level of Practice:
Your Political Party: Republican Democratic Independent Not Political
Your Annual Income: Under $100K $100-150K $150-250K $250-500K Over $500K
Describe yourself:
Describe your work schedule:
Why are you considering our matchmaking service to help you?
Describe your background:
Describe your relationship goals:
What are you passionate about?
How do you like to spend your free time?
Do you participate in any sports, activities, or hobbies?
Do you workout? Yes No Occasionally
If yes, how many times a week?
What is the status of your health? Excellent Good Fair Poor
Do you have pets? Yes No
Do you drink? Never Rarely Social Moderate Heavy
Do you smoke? Yes No
Are you open to dating someone outside of Orange County?
Check all of the traits that describe to you: Active Adventurous Affectionate Ambitious Argumentative Athletic Clean cut Conservative Creative Devoted Easygoing Eccentric Emotional Flexible Giving High Energy Humorous Intellectual Playful Musical Organized Reliable Romantic Sarcastic Sexy Shy Simple Social Spontaneous Talkative Thoughtful Witty Worldly
Has a restraining order ever been filed against you? Yes No
Have you ever been convicted of a felony, sexual offense or required to register as a sex offender? Yes No
YOUR MATE
Describe the type of mate you would like to meet?
What are the top three most important traits for your mate to possess?
Are there any deal breakers or things you will not tolerate in your mate?
Physical Preference:
Desired Age Range:
Desired Height Range:
Mates Desired Annual Income: Under $100K $100K+ $150K+ $250K+ $500K+ Does Not Matter
Do you prefer your mate with: Full Time Career Works Part Time Retired Does Not Matter
Would you date someone with children? Yes No Maybe
If maybe please explain:
Mates Desired Race: Caucasian Asian Latino Indian African American Middle Eastern Other Other:
Mates Desired Religion Agnostic Atheist Buddhist Catholic Christian Does Not Matter Jewish Spiritual Other Other:
Is political party important? Yes No Maybe
Is smoking acceptable? Yes No Maybe
What is the best time for us to contact you?
How did you find out about us?
By executing this questionnaire, you declare all of the information stated to be true and correct.
Ladies, after clicking the submit button below, don't forget to complete Step 2.
