APPLICATION FOR A PIECE OF ASS

  Approved___________                          Tested For Aids?__________

  Denied_____________                          Physician_________________

  Name____________________________
  Address_______________________________
  Age_____ Phone____________Social Security#______________________________
  Hair Color________ Real?_______ Eye Color__________ Real?___________
  Dentures?____________ Height_________ Weight_________ Waist Size_______
  Marital Status: Married_______ Single_______ Divorced_______ Other_____
  Chest or Bra Size_________________ Are they real?________________
  Do you like them: Sucked__ Chewed__ Kissed__ Carressed__ Squeezed_____
                    None of the above_____ other_____
  Can you stay out late?__ How Late?____ All Night____ Several Days?__
  Do you like to be screwed?_______________ How often?__________
  Do you like Oral Sex?_______________________
  Penis or Pussy Size: SM____ Med_____ LG______ EX LG______
  While Screwing do you: Faint__ Fart__ Cry__ Moan__ Hum__ Scream__
        Whistle__ Yodel__ Scratch__ All of the above__
        Just lay there__ Other__________________________
  When you come, Do you: Wiggle__ Wobble__ Twist__ Jerk__ Scream__
        Cry__ Other?________________________________________
  What kind of screw do you like? Fast__ Slow__ Super Fast__
                                  All night___________
  How many times_______ Comments_________________________________________
  How long do you screw at one interval?_________________________________
  Do you want to screw now? _________________
  If you have screwed before, Give 2 References (Not Immediate Family)
  Name__________________________ Address___________________ Phone_______
  Name__________________________ Address___________________ Phone_______

  If the Application is favorable, what are your charges? If any?
       For one night____________ One Hour___________
       Muff Burger Special or Blow Job______________
  What credit card will you Accept? Master Card?________ Visa?_________
       Sears?_______ JC Pennys?_____________ Shell?_______________
       American Express?_____________ Citicorp?______________

       I verify the Above Information is the Truth, So Help me God!!

                                ___________________________________
                                  Signature

                                ___________________________________
                                  Date