Pre-Interview Questionnaire
I'd like to learn a bit more about you before we get started.
Today's Date
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Month
-
Day
Year
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Two letter abbreviation for the state you currently reside in:
Submit Pictures
Please submit 1-2 pictures of yourself. Submitting graphic or distasteful pictures will automatically disqualify you from our service, and you will not receive a response.
Image #1
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Image #2
Note:
Orly's services are paid matchmaking services. Please enter your matchmaking budget below.
What is the overall budget range, you are looking to spend, to find your soul mate?
*
Let's get to know you...
Before we begin, I need to get to know you a bit, so I can help you find the perfect match. Please fill out as much as you can, and remember.. BE HONEST.
First Name:
*
Last Name:
*
Nickname:
*
Male / Female:
Please Select
Male
Female
Primary Phone Number
*
-
Area Code
Phone Number
Email Address:
*
Your Age:
Date of Birth
-
Month
-
Day
Year
Date Picker Icon
Age you pass for:
Citizen for which Country?
Your Birthplace:
Annual Income:
*
Net Worth:
What languages do you speak?
Your Sign:
Please Select
Aries
Taurus
Gemini
Cancer
Leo
Virgo
Libra
Scorpio
Sagittarius
Capricorn
Aquarius
Pisces
Eye Color:
Are you religious:
Yes
No
Spiritual
What is your religion:
Hair Color:
Height:
Are you single:
Yes
No
It's Complicated
Weight:
How long have you been single?
Divorced:
Yes
No
It's Complicated
How long?
Widowed?
Yes
No
It's Complicated
How long?
Close to your family?
Yes
No
It's Complicated
Where are your parents from?
Are they together?
Yes
No
Do you have children?
Yes
No
How many?
Do they live with you?
Yes
No
Shared Arrangement
Other
What are their names and ages?
I want a:
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Marriage
Long-term Relationship
Just a Date
Companion
Start a Family
Occupation:
*
Name of School / College:
Year Graduated:
What are your hobbies:
What are your goals:
Do you smoke:
Yes
No
On Occasion
I want a:
Smoker
Non-Smoker
No Preference
Describe your looks and personality:
Would you like to know your date's feedback about you:
Yes
No
What do you have to offer your mate:
What is your current housing situation:
Own a house
Own a condo
Rent / Lease a house
Rent / Lease a condo
Other
Proceed to page 2 of 3
If the "Next" button doesn't work, make sure you have filled out all the "required" fields above.
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Next
What are you seeking?
Tell me what you can about the person you would like to meet. Be Direct.
I would like to meet a:
Man
Woman
Both
What is your sexual preference
Heterosexual
Homosexual
Bisexual
Annual income range of the person you would like to meet:
Age bracket:
Height Range:
General Looks:
Ethnicity / Nationality Preferences:
White
Black
Asian
Latino
Middle Eastern
American
European
No Preference
Any specific countries or nationalities preferences:
Children:
Without Kids
With Kids
No Preference
Marital Status:
Never Married
Diviorced
Widowed
Open
Are you relocating:
Yes
No
In Transition
If so, where to:
The Absolute "No-No's"
Any Occupation Preferences:
His or Her Goals
Describe the Person of Your Dreams:
Describe Your Preferences in Terms of Looks:
Describe Your Preferences in Terms of Personality:
Proceed to page 3 of 3
If the "Next" button doesn't work, make sure you have filled out all the "required" fields above.
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Next
Personal Information
Confidential Information About You (For Official Use Only)
Home Phone #:
*
Work Phone # (or 800):
Fax #:
Cell #:
*
E-Mail Address:
*
Website Address:
Home Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
United States
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
Work Address:
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
United States
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
Best Hours to Reach You:
Morning (8a - 12p)
Afternoon (12p-5p)
Evening (5p - 8p)
Anytime
Emergency Contact Name:
Emergency Contact Number:
Where did you hear about our services:
For Clients you refer to our service, you would like to receive:
Bonus of Upgrading
More Time on My Membership
Ability to Switch Programs
Open
Social Security Number:
Driver's License Number:
Driver's License State:
Before Submiting:
Orly will only review only full and completed pre-interview questionnaires. This includes all questions as well as submitting photos. Submissions not including photos will not be reviewed.
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