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This is a Preliminary Survey designed to help you provide compatibility characteristics concerning yourself and the person you’d like to meet.  All information that you have provided will be held in the strictest confidence.

What We'd Like to Know About You
 
What is your marital status?
Are you new to the area?
What is your highest level of education?
What’s your current occupation?
Your Income: 
What are your relationship goals?
How long have you considered finding an alternative way of meeting people? 
How did you hear about us?
What encouraged you to complete this questionnaire? 
  
Who you would like to meet?

 
I prefer to date people from the age of to    or It doesn’t matter
I would date someone with children 
I prefer to meet someone who has… 
I would date someone who smokes 
I wish someone shared my interest in… 
I like people between feet inches and feet inches 
or It doesn’t matter
Things that attract me to someone of the opposite sex are:

Your Contact Information

 
First Name
Last Name

Age 

Male   Female   
Today's Date
Email Address:
Home telephone
Work telephone
Address

City
State
Zip 

Typical Work Hours
What is the best time to reach you? 
 


 
         
Copyright (c) 2008 Allentown Introductions, Inc.