Please complete the following questionnaire about yourself and the person you would like to meet. We will be in touch to make an appointment for you to talk to one of our consultants. Please don't be shy, be HONEST. Your honesty will make the search for a compatible partner much easier.

Important: download and read the
Serendipity service agreement [120Kb pdf]

Contact Details
!Email:
!Name:
Street Address:
City/Town:
Postcode:
!Phone (BH):
!Phone (AH):
Occupation:
Your Attributes
Date of Birth:
Height:
Slim Average Cuddly Heavy
Weight:
Hair colour:
Eye colour:
No Social Yes
Smoker:
No Social Yes
Drinker:
Interests, hobbies:
Personality:
Travel
Yes No
Own transport?:

How far would you travel to meet a companion?

Local 100Km 200Km 300Km

Have you contacted Serendipity before?

Yes No
How did you find out about us?
Border Mail Twin Cities Post The Land Shepparton Advertiser
Newspaper:
Google Yahoo MSN Other
Search engine:
Prime Win Ten
Television:
About companion

I would like to know more about (quote client reference number) ...

Client:

... or give a description

Age group:
Never married Separated Divorced Widowed
Marital status:
Yes No
Children OK:
Height:
Slim Average Cuddly Heavy Don't care
Weight:
No Social Yes
Smoker:
No Social Yes
Drinker:
Interests, hobbies:
Personality:
Photograph

You may attach a recent photograph here. A vertical head and shoulders portrait is preferred. Please keep file size below 100Kb.

Agreement

Check the box below to indicate that you have downloaded, read and accepted the service agreement [120Kb pdf]

I accept:
Comments

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