INFORMATION FORM

TO HAVE SOMEONE CONTACT YOU, PLEASE COMPLETE THE FOLLOWING FORM

REPRESENTATIVES USE CALL BLOCK AND DISCRETION IS ASSURED AT ALL TIMES
 

Fields in red are required to be completed.

First Name:      Home Phone: Area Code  
Last Name: Home Phone Number:  
Gender: Male:   Female: Cell Phone:  Area Code
Your Age:   Cell Phone Number:
Address: What number is best to contact you at? Home:   Cell.:
Town / City:   Ages you would like to meet?

From:  To:
Type of work you are in? Position?  or  Retired?

          How did you hear of Sincere Singles?   (Multiple choices accepted)
 

Newspaper     Yellow Pages     Decal    T.V.    Referral     Other
          Best time to call:  
          Monday to Friday: Mornings   Afternoons     Evenings   Anytime
          Weekends: Mornings   Afternoons     Evenings   Anytime

          Sincere Singles accepts - Single, Separated, Divorced, or Widowed only.
 

          Are you?

        Single:    Separated:      Divorced:      Widowed:

Comments you would like to make about yourself:

Comments you would like to make about your match:

 
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Sincere Singles Professional Introduction Service. (1992)