Please enter the heading/age(s) of the person(s) you would like to meet
(from our advertiser page)

Have you ever contacted us in the past?
YES NO

HI, I AM...

Male     Female     Marital Status: Single Divorced Separated Widowed

*Full Name:

*Address 1:

Address 2:

*Phone (Home):     

*Phone (Business):

Mobile:    

E-Mail:

Occupation:

About Me:
(please don't be shy, be honest, we can't all be super models or studs!)

D.O.B.(dd/mm/yy):     Smoker:    Yes     No

Height:     Weight:

Children:    Yes     No     If yes, How Many:

I would describe my personality as:
(please tick more than one)

Fun Loving:     Open Minded:    Positive:     Confident     Introvert:

Extrovert:     Outgoing:     Quieter Type:     Well Groomed:     Casual:

Hardworking:     Ambitious:     Good Communicator:     Humorous:

Romantic:     Affectionate:     Spontaneous:    

Down to Earth:     Outdoorsy:

In my spare time I enjoy:
(please tick more than one)

Dining Out:     Night Clubs:     Dancing:     Home Life:     Snow Skiing:

Horse Riding:     Bush walking:     Going to Beach:     Animals:

Any other details:

I'M LOOKING FOR...
(the more info you give us the easier it is to find your perfect partner)

I would like to meet someone who is:

Age Group (minimum to maximum):     

Smoker:    Yes     No

Build: Slim Slim-Average Medium Solid Athletic Cuddly Doesn't Matter     

Height (minimum to maximum):

Children:    Yes     No     If yes, how many:

Personality:

Fun Loving:     Open Minded:    Positive:     Confident     Introvert:

Extrovert:     Outgoing:     Quieter Type:     Well Groomed:     Casual:

Hardworking:     Ambitious:     Good Communicator:     Humorous:

Romantic:     Affectionate:     Spontaneous:    

Down to Earth:     Outdoorsy:

Other Requirements:
(eg: nationality, occupation etc...)

ALL INFORMATION IS STRICTLY CONFIDENTIAL