Anketa


	*A Very Personalized Matchmaking and Marriage Introductions Service*

NEW! We now accept payment via PayPal, Visa or Mastercard with secure online Transactions!

Here is where you may forward your personal information to Vitochka.com. Please be sure to fill out the form completely as possible. The more information that you give, the more interest you will generate and the more responses that you will likely have.

Photographs:

Please email up to six (6) quality photographs to us for inclusion on your page. Photos must be in the .jpg format and no more than 500kb in file size each. The photos should show you to best advantage. NO NUDE PHOTOS OR BATHING ATTIRE WILL BE ACCEPTED!

Email the photos to: admin@vitochka.com


	Information marked with an * will be shown on your page


	*First Name:


	Family Name:


	Date of Birth:


	*Age:


	Street Address & Apt. #:


	*City


	State/Region:


	Postal Code:


	*Country:


	Home Phone #:


	Cell Phone #:


	Email Address:


	*Marital Status:


	*Occupation:


	*Education:


	*Number of Children:


	*Age of Children:


	*Height (cm):


	*Weight (kg):


	*Hair Color:


	*Eye Color:


	*Smoke:


	*Alcohol:


	*Religious Preference:


	*Man’s preferred age range: from


	years to


	years of age.


	*Man’s Height Min/Max:


	*Man’s Weight Min/Max:


	*Man’s Desired Nationality:

*Man’s Personal Qualities:

*Your Personality:

*Your Interests and Hobbies:

*Your Personal Message for man:

If you are registered with other marriage agencies or singles web sites, please list them here:

Пресс "SUBMIT" чтобы послать анкетный опрос

Important compatibility note for Firefox and Mozilla users: The questionnaire may work a bit differently with these browsers. You may have to RIGHT CLICK on the first field to bring up the insertion point to begin typing; use the TAB key to move from field to field. After you submit the form, your email client software will come up with a ready-made message with your questionnaire answers already adressed to Vitochka.com; you simply send the message normally and we will receive your information.


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