Please select a JPEG (.jpg) file to be sent: Please include a short explanation: Name * First Name Last Name Gender * Male Female Phone # * (###) ### #### Email Address * Residence (City) * Residence (State) * How did you hear about us? * Birthday * MM DD YYYY Country of Birth? * If born outside the U.S., when did you move to the U.S.? Ethnicity * Religion/Faith * Political beliefs * Height * Weight * Body type * Thin Average Athletic Other Would you be willing to relocate? * Yes No Do you Own or Rent your home/apartment? * Own Rent Educational level * College attended (Name and Degree) * Employer Name * Occupation/Position * How long have you worked there? * Income * Do you smoke? * Yes No Do you drink? How often? * Do you do drugs (recreational or other)? * Do you have any medical issues, illnesses, or STD’s your partner should know about? * Do you have children? (If yes, ages) * Do you want children? * Yes No Would you date someone with children? * Yes No Do you have any pets (what kind)? * If you were married, or in a long-term relationship tell us why it ended? * * Favorite activities/hobbies? * What do you do to stay in shape and be active? * 3 Unique things about you (I won a Grammy, or I’m a great cook) * 1) * 2) * 3) Tell us about yourself. This part is very important in order for us to understand more about you, and what type of person you’re looking for: * ABOUT YOUR PARTNER Ethnicity * Religion/Faith * Political beliefs * Age range * Body type * Thin Average Athletic Other Gender * Male Female What are 3 non-negotiable's when looking for your Partner? * 1) * 2) * 3) Describe your ideal match * I ACKNOWLEDGE AND CERTIFY THAT THE ABOVE INFORMATION IS TRUE AND CORRECT. BY SUBMITTING BELOW, I CERTIFY THAT I'M AN UN-ATTACHED, SINGLE MALE OR FEMALE WILLING AND ABLE TO BE MATCHED UP WITH A POTENTIAL PARTNER, AND ENTER INTO A POSSIBLE RELATIONSHIP IF BOTH PARTIES AGREE. I AGREE TO ABIDE BY ALL THE RULES SET BY MATCH BY JULIA AND JULIA BENDIS, AND AS LISTED IN THE TERMS AND CONDITIONS ON MATCHBYJULIA.COM. I AGREE AND CERTIFY THAT I WILL DO MY DUE DILLIGENCE IN KEEPING ALL PROFILES SENT TO ME BY MATCH BY JULIA AND JULIA BENDIS PRIVATE AND CONFIDENTIAL. I CERTIFY THAT I WILL NOT SHARE PRIVATE PROFILES WITH ANYONE NOR WILL I LOOK UP THOSE INDIVIDUALS ON MY OWN, ON ANY SOCIAL MEDIA OR OTHERWISE. I ACKNOWLEDGE THAT ALL FEES PAID ARE NON-REFUNDABLE. IF I ENTER INTO A DATABASE MEMBERSHIP ONLY, THERE ARE NO GUARANTEES ON THE TIME FRAME OF POTENTIAL MATCHES FOR ME, NOR THE QUANTITY OF MATCHES Thank you! We will be in touch with you shortly. Please click here to attach 4 recent pictures of yourself - Resolution should be less than 1MB/each and jpeg format.
