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* Address: 
 
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Do you own or rent your home?: 
 
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Own 
Rent 
 
 
 
How Long?:  
 
* Best Contact Phone Number: 
 
* Best Contact Time: 
                                
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Morning Afternoon Evening Any Time   
 
 
* Best Contact Method: 
                                
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Home Business Cellular E-mail  
   
 
Home Phone:  
 
Work Phone: 
 
Fax:		 
 
Cellular:		 
 
* E-mail:		 
 
* How did you hear about Oksanalove.com Inc? 
 
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American Airlines American Music Awards American Way Atlanta Magazine Beverly Hills British Airways Cathay Airlines Magazine CNBC CNN Traveller Continental Airlines Delta Sky Magazine Destinations Magazine Directors Guild of America Diversion Magazine Dupont Registry Magazine Family Forbes Magazine Formula One - Black Book Fortune Magazine Friend Frontier Airlines Wild Blue Yonder GO Magazine Google Haute Living Magazine Los Angeles Haute Living Magazine New York Helen Woodward INC Magazine Kiplingers Financial Magazine Living La Jolla Luxury Magazine Lycos MaxJet Millionnaire Magazine Money Magazine MSN Naples Illustrated Magazine New York Magazine NFL Alumni Magazine Performances Magazine (Los Angeles Area) Pacific Palisades Palm Beach Illustrated Points North Producers Guild of America Rancho Santa Fe Review Resort Living Magazine Robb Report Magazine Robb Report Collections Robb Report Motorcycling Rolls Royce Owners Diary San Diego Lawyer San Diego Magazine Santa Monica Sun Showboats Smart Money Smart Money Ref List Stratos Tampa Bay Illustrated Trump World U.S. Airways Inflight Magazine United Airlines Inflight Magazine Unknown Wine Country Living Magazine Worth Wealth Collection Yahoo Other Internet Search Engine Other Airline Magazine  
 
 
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Please contact me as soon as possible -     I am ready to get started - I would like to schedule a complimentary -      appointment with a consultant - Other  
 
 
Please explain: 
 
Have you experienced other services? 
 
Please explain: 
 
Do you travel internationally? 
 
 If Yes, How Frequently? 
                                
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Occasionally Weekly Monthly Quarterly Annually   
 
 
 To Which Destinations: 
 
* Place of birth:		 
 
* Date of birth: 
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* Gender: 
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F 
M 
 
 
* Height: 
 
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4 5 6 7  
Feet   
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1 2 3 4 5 6 7 8 9 10 11  
Inches   
 
* Weight: 
 
Hair Color: 
                                
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			Blonde Black Brown Red White Grey None  
 
 
Eye Color: 
                                
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			Brown Blue Green Hazel              
 
 
Education: 
                                
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			BS BA MA MS College Some College Junior College High School Vocational Masters Degree MBA MA Ph.D. M.D. D.D.S. JD MBA Bachelor Degree Graduate Degree Associate Degree University Graduate Specialized Degree BBA EdM Multiple Degrees (Describe below)   
 
 
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* Occupation: 
 
Describe your occupation:  
 
* Income: 
 
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5,000 - 10,000 10,000 - 25,000 25,000 - 50,000 50,000 - 75,000 75,000 - 100,000 100,000 - 150,000 150,000 - 200,000 200,000 - 300,000 300,000 - 400,000 400,000 - 500,000 500,000 - 750,000 750,000 - 1 Million 1 Million +  
 
 
Select the Currency in which your income is stated: 
 
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US Dollars Euros Britsh Pounds  
 
 
Assets: 
 
Employed By: 
 
Are you self-employed?:			  
 
* How much of a financial investment are you prepared to make to find your desired companion?:  
                                 
             - No Selection -  3,000 3,000 - 6,000 6,000 - 10,000 10,000 - 25,000 25,000 - 50,000 50,000 - 75,000 75,000 - 150,000 150,000 - 250,000 250,000+ 500,000+ Whatever it takes    
 
 
Select the currency of your financial investment: 
                                
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US Dollars Euros Britsh Pounds              
 
 
Are you emotionally prepared for marriage?   
                                
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			1 2 3 4 5 6 7 8 9 10              
 
 
Are you emotionally prepared for a committed relationship?   
                                
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						1 2 3 4 5 6 7 8 9 10              
 
 
Please comment on your emotional preparedness:  
 
Marital Status: 
                                
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			Never married Separated Divorced Widowed              
 
 
If you are separated, divorced,  
                                            
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Years                                             
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0 1 2 3 4 5 6 7 8 9 10 11                          
Months 
 
Have you been  
 
If yes, how long?: 
                                            
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Years                                              
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																								0 1 2 3 4 5 6 7 8 9 10 11  
 Months 
 
Do you have children?:  
 
Number of Children:		 
 
Number of Children 
 
Please describe the sex 
 
Would you like to have  
 
About Yourself : 
 
 
 
What community activities do you participate in?:  
 
What languages  
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English Only English and others No English - Others   
 
Please list any other languages you speak:  
 
Ethnic background:  
 
I am:  
 
 
Your Athletic Activities:  
 
 
 
Please describe any other activities:  
 
Do you watch sports?:			 
 
Please explain:  
 
Describe your life goals: 
 
 You attend church or synagogue: 
 
 
Comment on your religious beliefs and their influences on your life:  
 
Do you suffer from any medical condition?  
 
About your eating habits: 
  
 
Do you drink alchohol: 
 
Frequency: 
   
 
Are you an alcoholic?:  
 
If recovering, how long?:		 
 
 Do you smoke?: 
 
 Frequency: 
   
 
If yes, how long?:		 
 
Have you quit smoking?: 
 
  
 
Age: 
 
Comments on age:  
 
Rate their general attractiveness: 
                                
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1 2 3 4 5 6 7 8 9 10  
 
 
Height: 
 
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4 5 6 7  
Feet   
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1 2 3 4 5 6 7 8 9 10 11  Inches   
 
Weight:		 
 
Hair Color 
                                 
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Blonde Black Brown Red White Grey None  
 
 
Eye Color 
                                             
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									Brown Blue Green Hazel   
 
 
What physical qualities are you attracted to?:  
 
Ethnic Preference:  
 
About their athletic activities: 
  
 
Describe any other activities:  
 
Their occupation: 
  
 
Describe any other occupations:  
 
Their education: 
  
 
Other levels of education:		 
 
Their children: 
  
 
 Comment on children:		 
 
Their preferred annual income: 
                                
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			35,000 - 50,000  50,000 - 100,000  100,000 - 300,000  300,000 - 500,000  500,000+ Not Important   
 
 
Income level comments:		 
 
 Their cultural interests: 
  
 
Other cultural interests: 
 
Their musical interests: 
  
 
Comments on musical interests:		 
 
Views on smoking:  
 
Views on alcohol:  
 
  
What are the three most important considerations about the person you want to meet?   
1.   
2.  
3.  
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