Application for a Piece of Ass

Approved ( ) Yes  ( ) No
Denied ( ) Yes  ( ) No

Tested For Aids? ( ) Yes  ( ) No
Tested For STDs? ( ) Yes  ( ) No
Physician_________________


  • Name____________________________
  • Address_______________________________
  • Age_____
  • Phone____________
  • Social Security#______________________________
  • Hair Color________
    Real? ( ) Yes  ( ) No
  • Eye Color__________
    Real? ( ) Yes  ( ) No
  • Dentures?
    ( ) Yes  ( ) No
  • Height_________
  • Weight_________
  • Waist Size_______
  • Marital Status:
    ( ) Married
    ( ) Single
    ( ) Divorced
    ( ) Attached
    ( ) Cheating
    ( ) Other
  • Chest or Bra Size_________________
    Are they real? ( ) Yes  ( ) No
  • Are your nipples:
    ( ) Small
    ( ) Medium
    ( ) Large
    ( ) Pink
    ( ) Peach-colored
    ( ) Dark
  • Do you like them:
    ( ) Sucked
    ( ) Chewed
    ( ) Kissed
    ( ) Caressed
    ( ) Squeezed
    ( ) None of the above
    ( ) Other_________
  • Can you stay out late?
    ( ) Yes  ( ) No
    How Late?____
    All Night____
    Several Days?__
  • Do you like to be screwed?
    ( ) Yes  ( ) No
    How often?__________
  • Do you take it in the ass?
    ( ) Yes  ( )No
  • Do you like giving Oral Sex?
    ( ) Yes  ( ) No
    Receiving?
    ( ) Yes  ( ) No
  • Penis or Pussy Size:
    ( ) Microscopic
    ( ) Small
    ( ) Medium
    ( ) Large
    ( ) Extra Large
    ( ) Does it matter?
  • Are you shaved?
    ( ) Yes  ( ) No
  • 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
    ( ) Moan
    ( ) 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?
    ( ) Yes  ( ) No
  • 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
  • Do you have any pictures to attach?
    ( ) Yes  ( ) No
  • If you don’t have any pictures to attach, will you pose for some?
    ( ) Yes  ( ) No

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

___________________________________
Signature

___________________________________
Date