Note: This application will be incomplete and rejected unless accompanied by a complete financial statement, criminal history, driving record, job history, and current health record/medical report from your physician.
Date of Birth: ____________________________________
Height: _____________ Weight: _____________________
IQ: ________ Social Security Number: ________________
Drivers License Number: ___________________________
Home Address: ___________________________________
Do you own a van? _________
A truck with oversized tires? ________
A waterbed? ________
A pick up with a mattress in the back? ______
Do you have an eyebrow, nose ring, or belly button ring? _______
A tattoo on your neck? ________
Do you have a mullet? ________
NOTE: If you answered yes to any of the last 7 questions, discontinue and leave premises.
How many times have you been married? _____________________
How many times have you been divorced? _______________________
Have you ever cheated on a girlfriend or wife? ______________________
When going on a date, who should pay? _________________________________
Have you ever been accused or convicted of stalking? ______________________
If I tell you to drop dead today will you continue to contact me? ______________
Do you know how to cook? __________________
What is your relationship like with your mother? _____________________
(you shouldn’t need ANY more space than that for this answer)
Do you own a dog? _______________
What is your definition of an alcoholic? ____________________________
Do you like kids?___________________
Do you have kids? ____________________
Do you pay child support? _______ How much? ___________
Have you ever been late on your child support payments? ________
How much baggage do you carry?___________
Are you able to fix my car?____________
Do you own a home?____________Have you ever been late on your mortgage?_________
What kind of vehicle do you drive? ___________
Do you have a car payment? __________ How much is it? ____________
Do you know the different between the dinner fork and the salad fork? __________
In 50 words or less what does “LATE” mean to you? ______________________________________________
In 50 words or less, what does “STALKING” mean to you?__________________________________________________
In 50 words or less what does “GOING ON A DATE” mean to you?
Your signature indicates that all answers are TRUE. If you are found falsifying answers and/or documents you will be sent hunting with Cheney.
Thank you for your interest. Please allow four to six years for processing. You will be contacted in writing if you are approved. Please DO NOT call or write during the processing time.