Elite and Private Matchmaking — Worldwide (for well-to-do bachelors seeking the right woman.)

CONFIDENTIAL PROSPECTIVE CLIENT INFORMATION FORM

1. Your First and Last name:

2. Your Contact Email Address:

3. City and State you primarily reside:

4. Your age:

5. Your height (ft.' in."):

6.Your annual income:

7. Your approximate net worth:

8. Are you separated, divorced, widowed or
single-never-married?:

9. If you have children what are their ages?

10. Have you worked with an elite matchmaker before?

11. How did you hear about the 4M Club?

12. Are you primarily seeking marriage, a long-term relationship or casual dating?:

13. What age range is your ideal woman?:

14. How long have you been without a girlfriend/wife?:

15. Why would you like to hire a private matchmaker? i.e. "hate Internet dating," "too busy," etc.:

16. On a scale of 1 (least) to 10 (most), how serious are you about finding a soul mate?:

17. How soon would you want to join, if we both determine we're a professional match? (please keep in mind we work with a very limited number of clients, to keep the experience and service at an exceptional level.):

18. Fee you'll consider for exclusive matchmaking and consulting? We never work with more than a handful of clients at a time, for one-on-one special service. We can discuss actual matchmaking plans later. Please choose:

Your preferred range:

PLEASE NOTE: An Engagement or Marriage Bonus (whichever occurs first) will also be incorporated in our user friendly contract...we can discuss bonus amount you determine fair at the appropriate time. Should your relationship end for any reason after bonus is paid (within 18-months after payment), we work with you at no extra charge for one year.

19. How much time do you prefer to have (length of matchmaking plan) when meeting matches? Factor in your busy work schedule or lifestyle, and any traveling likely happening when meeting someone. You approve and choose from each candidate we present, or we find you somebody else until you're happy.

Length of time if longer:

20. I would like Chris to call me at her earliest convenience; my phone number is:

21. I will call Chris at my convenience, and I look forward to learning more: Yes No

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Chris will review your information shortly. Again, your information is always kept confidential.