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Have you been searching for that single lasting relationship-that special someone with whom you can share your time, your love and your future? We know you have options, but doubt you have anything available to you that is as effective as Successful Singles has proven to be.

We have 36 years of experience and thousands of successful relationships to our credit. Out method, Compatibility Profiling System™, and our exclusive matching approach is proven to you give the optimal experience in meeting people for a long-term relationship.

Be open-minded and proactive by taking the first step in the right direction. Call us at 1-800-698-2222, or complete the information below. Let's us show you what makes us different!

All information is strictly confidential and will not be used for any purpose other than this initial contact information. Please note (*) denotes a required field.

Tell us Who You Would Like to Meet:

How important is physical appearance?
How important is your partners intelligence?
Within the next 6-12 months what type of relationship would you like to be in?
Would you prefer to meet someone whose marital status is? *check all that apply Never Married Divorced
Legally Separated Widowed
I am looking to meet someone whose age is between:
Do you want to meet someone with or without children?
Regarding activity level, would you prefer to meet someone who is?
Do you prefer to meet a nonsmoker or a smoker?
What are the three most important qualities you desire in a partner?



What is your preference regarding religious affiliation? *check all that apply

Catholic Protestant Born Again Christian
Jewish Atheist Other Doesn't Matter

Tell A Little About Yourself:

*Email:
* First Name:
Last Name:
* Date of Birth:
Sex: Male Female
Marital Status:
Address:
City:
State:
*Zip:
Occupation?:
Do you live in:
Only one phone number is required. 
*Home Phone:
*Work Phone:
* Cell Phone:
I prefer to be reached at:
Best time to be reached: To:
Do you smoke?: Yes No
How did you become aware of Successful Singles?


At this point you have the option of completing our Compatibility Attitude Profile or submit just this portion and taking the complete profile at a later time. The profile contains 38 questions, and takes approximately 1 minute.

For the safety of our members and to ensure a quality service, we require that you provide us with at least one phone number. A representative from Successful Singles will contact you within 24-48 hours, at the telephone number that you provided in this form. All information is confidential, and is protected and Copyright© 2005 Successful Singles, Inc.

 



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Life is short and you deserve to share your life with special someone.
Call us at
800-698-2222 for a initial consultation.

 

 









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