Personal Profile Submission Form

This form is for non credit card holders, or people who don't feel comfortable paying via Internet. The alternative way of payment is to pay via MoneyGram

If you prefer to pay online via credit card, click HERE.

You must have the Money Gram money transfer control number to complete the form.

Fill in your details and mark the service you choose. Once you press the button "Submit Form", you will be taken to a confirmation page.

The information submitted will be treated as strictly confidential. I will never give away your name and address for use in any way other than stated. If you have any questions regarding the processing of your order, please contact us.

Yes, I would like to use the following services:

Starter Help Package

Please provide the following contact information:

Name
Address	Use only in offline ad Use in online ad, too
Country
Phone
FAX
E-mail #1	(for offline catalogue)
E-mail #2	(for online catalogue)

Please describe yourself:

Age
Height
Weight
Hair color
Eye color
Race

Marital status:

single
divorced
widower
married

Do you have children? no yes

If yes, please specify gender and age.

Education (you may mark several options):

school
special
college
university
postgraduate

Occupation:

Interests and hobbies:

Personality:

Religion:

Smoking

no
sometimes
yes


Requirements to a partner: (If parameter is not important for you, leave the windows blank.)







Your Message (maximum 1000 characters):
(For sending data to local Russian marriage agencies and placement in the online catalogue)

Billing:
Money Gram money transfer control No.

I understand that the data I will receive are intended solely for my personal use, and may not be sold or in any way distributed to a third party.

Please press the button only once, it will take some time to process a query. Make sure that the email address you submitted is correct.