(Please fill in all blanks)
Name (last): ________________
(first-please check one):
(_) Billy Bob
(_) Billy Joe
(_) Billy Ray
(_) Billy Sue
(_) Billy Mae
Age: ________
Sex: (_) Male (_) Female (_) N/A
Shoe size: ___ left ___ right
Occupation:
(_) Farmer
(_) Mechanic
(_) Hair dresser
(_) Unemployed
Spouse's name: ___________
Relationship to spouse:
(_) Sister
(_) Brother
(_) Aunt
(_) Uncle
(_) Cousin
(_) Mother
(_) Father
(_) Son
(_) Daughter
(_) Pet
Number of children in household: ____
Number of children that are yours: ____
Mother's name: ____________________
Father's name: _____________________ (If not sure, leave blank)
Education (Circle highest grade completed): 1 2 3 4
Do you (_) Own or (_) Rent your mobile home?
___ Total number of vehicles that you own
___ Number of vehicles that still crank
___ Number of vehicles in front yard
___ Number of vehicles in back yard
___ Number of vehicles on cement blocks
Number of firearms you own and where you keep them
___ Truck
___ Bedroom
___ Bathroom
___ Kitchen
___ Shed
Model and year of your pickup: _____________ 194__
Do you have a gun rack: (_) Yes (_) No
If no, please explain: ____________________________________________
Newspapers/magazines you subscribe to:
(_) The National Enquirer
(_) The Globe
(_) TV Guide
(_) Soap Opera Digest
(_) Rifle and Shotgun
___ Number of times you've seen a UFO
___ Number of times you've seen Elvis
___ Number of times you've seen Elvis in a UFO
How often do you bathe?
(_) Weekly
(_) Monthly
(_) N/A
Color of teeth:
(_) Yellow
(_) Brownish-yellow
(_) Brown
(_) Black
(_) N/A
Brand of chewing tobacco
(_) Red Man
How far is your home from a paved road:
(_) 1 mile
(_) 2 miles
(_) Don't know
Thank you. Your form will be processed and you will be contacted.
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Quote
What do you call a blonde standing on her head?
A brunette with bad breath!!
Justin Illusion...
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