International Introductions

Questionnaire Form

    The below client background information is required under the International Marriage Broker Regulation Act of 2005. If you answer "Yes" to any of the questions below, please provide a detailed statement of explanation and information.

    a. solely, principally, or incidentally engaging in prostitution;

    b. a direct or indirect attempt to procure prostitutes or persons for the purpose of prostitution; or

    c. receiving, in whole or in part, of the proceeds of prostitution.

    By sending this document to us you are certifying and attesting under penalty of perjury and false statement, that my above INFORMATION IS TRUE AND COMPLETE. I also give my permission to International Introductions to release and provide this information in any format to all interested foreign ladies available. I have provided any necessary additional truthful documentation to all questions answered 'Yes' above. I hereby waive any privacy rights from release of this information. I also hereby release and hold harmless and forever discharge International Introductions from any and all liabilities arising from my release of this information and any use of it, and arising from any and all company services, offerings, benefits and assistance.

    Please review Pricing & Services and place purchase prior to completing this questionnaire. After sending questionnaire please email pictures to