Friend with Benefits Application Form

Fill out this Friend with Benefits Application Form.

Questions for Friend with Benefits Application Form

1.

Name

The answer should be a text input.
2.

Nickname

The answer should be a text input.
3.

Age

The answer should be a number input.
4.

Gender

The answer should be a single choice:
  1. Male
  2. Female
  3. Other
  4. Prefer not to say
5.

Height

The answer should be a text input.
6.

Weight

The answer should be a number input.
7.

Eye Color

The answer should be a text input.
8.

Hair Color

The answer should be a text input.
9.

Natural Hair Color

The answer should be a text input.
10.

Address

The answer should be a text input.
11.

City

The answer should be a text input.
12.

State/Province

The answer should be a text input.
13.

Postal/Zipcode

The answer should be a number input.
14.

Home phone number

The answer should be a phone number.
15.

Cell Phone number

The answer should be a phone number.
16.

Email Address

The answer should be a email input.
17.

Are you a virgin?

The answer should be a single choice:
  1. Yes
  2. No
18.

If not, at what age did you lose your virginity?

The answer should be a number input.
19.

Do you have children?

The answer should be a single choice:
  1. Yes
  2. No
20.

 If yes, how many?

The answer should be a number input.
21.

Do you have any STDs

The answer should be a single choice:
  1. Yes
  2. No
22.

Do you drink?

The answer should be a single choice:
  1. Yes
  2. No
23.

Do you use any illegal substances?

The answer should be a single choice:
  1. Yes
  2. No
24.

Upload your photo

File needs to be uploaded.
25.

Signature of Applicant

The answer should be a signature.
26.

Date of application

The answer should be a date input.

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Friend with Benefits Application Form

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