(08) 9371 0380
Solutions Matchmaking Perth

 

 

Membership Application

 

 

Membership Application


All fields are required.

Step 1. About You

Gender
Date of Birth
Age
Do you have any physical disabilities?
Marital Status
When was your last meaningful relationship?
What do you feel were the main reasons for separation?
Height
Build
     
  
Hair Colour
Eye Colour
Heritage
Do you smoke?
Do you drink alcohol?
Are you...         
     
        
        
     
Do you have a criminal record? If yes, state the nature.
Would you like your profile and/or photographs placed on our website free of charge?
Are you available to be matched immediately?
How did you find our about Solutions?

Step 2. Transport and Accommodation

Which vehicles do you own?         
What is your accommodation?

Step 3. Your Children

Do you have any children?
Number of children
Age/s
Custody or Access?
Do you wish to have children in the future?
If so, how many?

Step 4. Your Interests

What is your religion?
                                                                                   
How would you describe yourself?
Is your long term goal to find:

Step 5. Your Contact Details

First name
Last name
Phone
Email
Can be given out
Postal Address
Address 2
Suburb
Postcode
State

Step 6. Occupation and Nationality

What is your occupation?
Employed By
Education Qualification
What is your nationality?
Years in Australia

Step 7: Your Requirements In A Partner

Gender
Age Range
Occupation
Marital Status
Would you meet someone with dependent children?
Minimum Height
Build
     
     
Preferred Heritage
              
Location
     
Would you meet someone who smokes?
Would you meet someone who drinks alcohol?
Personality / Way of life
State other qualities you admire in a partner
Would you meet a partner who works away?
Would you relocate for the right partner

Step 8. Identification & Payment

Driver's License Number
Medicare Number
Passport Number

NOTE: NO REFUND WILL BE MADE UNDER ANY CIRCUMSTANCES. THE COMPANY AND/OR PROPRIETOR SHALL NOT BE RESPONSIBLE AND LIABLE FOR ANY CLAIMS, DAMAGES OR ANY OTHER LIABILITIES WHICH MAY ARISE DURING AND AFTER THIS APPLICATION HAS BEEN MADE.

I FULLY UNDERSTAND AND ACCEPT THE CONTENTS OF THE ABOVE. I CERTIFY THAT ALL THE PARTICULARS GIVEN ARE TRUE TO THE BEST OF MY KNOWLEDGE AND THAT I AM IN A POSITION TO MEET UNATTACHED PARTNERS OF THE OPPOSITE SEX.

APPLICATION COST: $990 / 3 Months plus 3 Months FREE (total 6 months, incl. GST)

"I wish to take advantage of the online special at the cost of $990."
"I wish to pay by:"
  
If paying by Credit/Debit, a consultant will call you for that information.
DIRECT DEPOSIT INFORMATION
BANK: WESTPAC
ACCT NAME: Solutions Matchmaking Pty Ltd
BSB: 036 041
ACCT NUMBER: 235353

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