Single Search Application Form

This form is used to apply for Single Search Local Service, The America's Service or International service. When you finish, use the button labelled Submit which appears at the end of the form.

Please Note: Single Search service will not begin until we receive your payment. You can review our prices at this time if you wish.

Section 1 - WHO YOU ARE:

                Your name: 
            Email Address: 


                   Street: 
                     City: 
        State or Province: 
                  Country: 
       ZIP or Postal Code: 

                    Phone:  
               FAX Number:  
      
How would you like to be contacted?

     Call Only - Your Email address will never be released
     Email - Your phone number will never be released
     Call or Email Only
     Email Through Single Search - Email address and phone not released - Email will be forwarded
 
  
Your Gender (Click as appropriate):

     Male       Female      Homosexual     Bisexual 

            
Your Race (You may check up to two entries):

     White       Asian      
     Black       Hispanic 
    
     
Your Age:

     Under 30    40 - 44     55 - 59     Over 69
     30 - 34     45 - 49     60 - 64
     35 - 39     50 - 54     65 - 69    


Your Education: 

     Ph. D.       Junior College     
     Masters      High School
     Bachelors
 
   
Your Beliefs (Click on one or two):

     Christian      Hindu
     Jewish         Islamic
     Metaphysical  


Your Height:

     Less than 5 feet (152 cm)       5/7 to 5/11 (168 - 180 cm)
     5/0 to 5/2 (152 - 157 cm)       Over 5 feet 11 inches (180 cm) 
     5/3 to 5/6 (158 - 167 cm)
       

Your Weight:

     100 - 115 pounds (45 - 52.1 kg)        161 - 175 pounds (72.7 - 79.4 kg)
     116 - 130 pounds (52.3 - 59 kg)        176 - 190 pounds (80 - 86.2 kg)
     131 - 145 pounds (59.1 - 65.8 kg)      191 - 205 pounds (86.3 - 93 kg)
     146 - 160 pounds (65.9 - 72.6 kg)      Over 205 pounds (93 kg)


Your Body Type (You may pick one from each column):

     Petite               Lean            
     Small                Rounded         
     Average              Plump         
     Large         
     XLarge        


Your Health:

     Excellent      Fair
     Very Good      Herpes
     Good           HIV


Your Hair:

     Black          Auburn       Frosted
     Brown          Red
     Gray           Blond
   
  
Your Distinctions (you can pick up to two):

     Beard          Tattooed
     Mustache       Long Hair               
     Bald
    
   
Your Status:

     Single     Widow-Widower     Divorced     Separated


Your Children:

     None            Grown
     1 - 2           On their own
     3 - 4
     More than 4
       

Your Employment Status:

     Employed        Contract
     Self-Employed   Semi-Retired
     Unemployed      Retired


Your Income:

     Exceeds $100K      Exceeds $40K
     Exceeds $75K       Exceeds $30K
     Exceeds $50K       $30K or Less


Your Occupation:

     Entrepreneur       Military
     Professional       Other
     Skilled 
     

Describe Your Characteristics:

Select no more than five characteristics from the list below.    

     Assertive          Aggressive        Creative 
     Passive            Intense           Spiritual    
     Serene             Neat              Honest    
     Patient            Nurturing         Affluent     
     Active             Sensuous          Balanced 
     Optimistic         Humorous          Sensitive  
     Intelligent        Faithful          Loving       
     Sincere            Confident         Leader    
     Team-Player        Structured        Free Spirited 
     Responsible        Workaholic


Your Interests:

Select no more than five interests from the list below.

     Art                Politics          Reading         
     Film               Theatre           TV       
     Music              Flea Market       Cards             
     Travel             Dancing           Environment  
     Family             Spectator Sports  Fishing   
     Boating            Golf              Tennis        
     Skiing             Cooking           Outdoors 
     Hobbies            Water sports      Bowling     
     Computers          Working-Out       Photography  


Your Pets:

     Cats          Dogs
     Horses        Birds
     Fish          Other 


Any addictions:

    Drugs:           Cigarettes:                      Alcohol:
     None          None
     Light         1 pack per day                 Light
     Moderate      2 or more packs per day        Moderate
     Heavy         Ex-smoker                      Heavy
                                                       Recovering


Handicaps:

     None          Legs
     Arms          Sight
     Hearing


End of "Who You Are" Section




Section 2 - WHO YOU SEEK:


What gender do you seek:

     Male        Female      Homosexual     Bisexual 


What Race do you seek:

     White             Black
     Hispanic          Asian 


For ...

    Companionship      Marriage 
    Relationship       HIV+  


The age you seek

Pick one or two options below.  For example, clicking on Under 45 and Over
29 means that you seek someone between 30 and 44.  

     Under 65          Over 29
     Under 55          Over 34
     Under 50          Over 39
     Under 45          Over 44
     Under 40          Over 49
     Under 35          Over 59
     Under 30     


Education of the person you seek:

     Ph. D.            Bachelors
     Masters           Junior College 
 

Beliefs of the person you seek:

     Christian        Hindu          Metaphysical
     Jewish           Islamic 
    

Height of who you seek:

     Less than 6 feet 0 inches (1.83 meters)      Over 5 feet 6 inches (1.68 meters)
     Less than 5 feet 7 inches (1.70 meters)      Over 5 feet 11 inches (1.80 meters)
     Less than 5 feet 0 inches (1.52 meters)


Weight of who you seek:

     Less than 205 pounds (93 kg)               More than 100 pounds (45 kg)
     Less than 190 pounds (86 kg)               More than 130 pounds (59 kg)
     Less than 160 pounds (73 kg)               More than 160 pounds (73 kg)
     Less than 130 pounds (59 kg)


Body type for who you seek (You can pick one per column):

     Petite               Lean            
     Small                Rounded         
     Average              Plump         
     Large         
     XLarge     


Status of who you seek:

     Single     Divorced     Widowed


Children:

      None               OK if they are on their own 
      1 to 2 OK          OK if they are grown
      3 to 4 OK          


Employment status of who you seek:

     Employed      Self-Employed      Retired


Income of who you seek:

     Exceeding $75K     Exceeding $40K     
     Exceeding $50k     Exceeding $30K


The occupation of who you seek:

     Entrepreneur       Military
     Professional       Skilled
  

Describe the Characteristics of who you seek:

Select no more than five characteristics from the list below.    

     Assertive          Aggressive        Creative 
     Passive            Intense           Spiritual    
     Serene             Neat              Honest    
     Patient            Nurturing         Affluent     
     Active             Sensuous          Balanced 
     Optimistic         Humorous          Sensitive  
     Intelligent        Faithful          Loving       
     Sincere            Confident         Leader    
     Team-Player        Structured        Free Spirited 
     Responsible        Workaholic


The Interests of who you seek:


Select no more than five interests from the list below.

     Art                Politics          Reading         
     Film               Theatre           TV       
     Music              Flea Market       Cards             
     Travel             Dancing           Environment  
     Family             Spectator Sports  Fishing   
     Boating            Golf              Tennis        
     Skiing             Cooking           Outdoors 
     Hobbies            Water sports      Bowling     
     Computers          Working-Out       Photography  


Addictions you will accept:

    Drugs:           Cigarettes:                      Alcohol:
     None          None
     Light         1 pack per day                 Light
     Moderate      2 or more packs per day        Moderate
     Heavy         Ex-smoker                      Heavy
                                                       Recovering





Your preferred method of payment:




To submit your application, you must pick either America's Service,
an International or Local Service.







In order to submit your application you must read the following 
and indicate agreement below. 



I certify that all responses I have given on the Single Search 
Application are true and correct. I understand that my entry to the 
database may be permanently removed if it can be shown that I have 
falsified any information.


I understand that Single Search does not personally screen applicants, 
or verify information provided. I also understand that I should take 
normal precautions when "meeting" individuals through the Single 
Search Service.


I hereby indemnify and agree to hold Single Search National, its 
owners, and its employees harmless from any and all claims of damage 
whatsoever resulting from any introduction.


Click on the Agreed button to signify agreement. 



Agreed


When finished click on the Submit button.
Only press Reset if you want to start completely over.