Name: __________________________ Address: ______________________________ ______________________________ ______________________________ Age: __________ Phone: ___________________ SSN: _______________________ Hair Color: ____________ Real Hair Color: _________ Eye Color: __________ Dentures: ________ Weight: ________ Height: ________ Waist Size: ________ Chest Size or Bra Size: __________ Marital Status: Married___ Single___ Divorced___ Other___ Are Breasts or Balls Real? ______ Do You Like Them: Sucked____ Chewed____ Kissed____ Caressed____ Squeezed____ Other____ None of the Above____ Can You Stay Out Late? ___ How Late? ___ All Night? ___ Several Days? ___ Do You Like To Be Screwed? ___ How Often? ____ Do You Like Oral Sex? ___ Penis or Pussy Size: Small ____ Medium ____ Large ____ Extra Large ____ While Screwing Do You: Faint__ Fart__ Cry__ Moan__ Hum__ Whistle__ Scream__ Yodel__ Scratch__ Just Lay There__ Go To Sleep__ All of the Above__ List the Top 3 Positions You Like the Best: 1)___________________________ 2)___________________________ 3)___________________________ When You Cum Do You: Wiggle__ Wobble__ Twist__ Jerk__ Scream__ Cry__ Just Start Humping Like Hell__ What Kind of Screw Do You Like? Fast__ Super Fast__ Slow__ All Night___ How Many Times? _________________ Comments _____________________________ How Long Do You Like To Screw At One Interval? _________________________ If You Have Screwed Before, Give Two(2) References (Not Immediate Family) Name:______________________ Address:___________________ Phone:__________ Name:______________________ Address:___________________ Phone:__________ If Application Is Favorable, What Are Your Charges For: One Night______ One Hour_____ Muff Burger Special or Blow Job?__________ What Credit Cards Will You Accept? Master Card___ VISA___ Am. Express____ Sears___ JC Penney's___ All of the Above___ Others___