Name:______________________
City:______________________
State:_____________________
Age:__________ Phone:______________
SSN:_______________
Hair Color:__________
Real Hair Color:____________
Eye Color:___________
Dentures: __________
Weight: _________
Height:___________
Waist Size: __________
Breast or Bra Size: __________
Marital Status:
Married___________
Single______________
Divorced:_________ Other__________
Are Your Breasts Real? ____________
Do You Like Them:
Sucked_________ Chewed__________ Kissed____________
Caressed__________ Squeezed________ Licked_________
Other_____
All of the Above____________
Can You Stay Out Late? _____________ How Late?_____________
All Night? _________ Several Days? ___________
Do You Like To Have Sex And Be Screwed All Night? ____________
How Often? __________
Do You Like Oral Sex? _____________
Pussy Size:
Small ________ Medium __________
Large ____________ Extra Large __________
While Screwing Do You:
Faint______ Fart______ Cry______ Moan______
Hum______ Whistle______ Scream_______ Sing_______
Scratch___________ Just Lay There_________
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____________ All Speeds___________
How Many Times? _________________
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:__________
Would your service be Free of Charge?_______
If Application Is Favorable, And If Not Free,
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_________
Comments __________________________
COMMENTS
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