Brand of pick-up you are going to purchase:
(_)Ford (_)Dodge (_)Chevy (_)Nisaan (_)Jeep
Last name: ___________________________
First name:
Billy-_________________
OR
Susie-_________________
Age: ____ (_)Check here if unsure.
Gender: (_)M (_)F (_)Unsure
Spouse's Name: ______________________________
2nd Spouse's Name: __________________________
3rd Spouse's Name: __________________________
Lover's Name: _______________________________
2nd Lover's Name: ___________________________
3rd Lover's Name: ___________________________
Spouse's relation to you:
(_)Sister/Brother (_)Cousin (_)Parent
(_)Child (_)Aunt/Uncle (_)Pet
# of children living in your household: ____
# of children living in your shed: ____
# of children that you own: ____
Animals dwelling in your household:
(_)Dog (_)Cattle (_)Pig (_)Chicken
(_)Horse (_)Frog (_)Rabbit (_)Goat
Is your home mobile? (_)Yes (_)No
Do you (_)own or (_)rent your home?
Current Occupation:
(_)Farmer (_)Trucker (_)Waiter/ress
(_)Owning a family grocery store
(_)Unemployed
Highest Level of Education, by grade:
(_)Under 1 (_)1 (_)2 (_)3 (_)4
Size of your yard, in acres:
(_)1-4 (_)5-10 (_)More than 10
Distance from your home to nearest city/town, in miles:
(_)10-20 (_)20-40 (_)More than 40
# of vehicles in your yard: ____
# of vehicles that you own: ____
# of guns/firearms you have: ____
Brand of your tractor: ___________
Total gambling debt this year: $_______
Model & year of your pick-up:
______________________, 194_
Hobbies/Interests:
(_)Farming (_)Brewing (_)Card Gaming
(_)Hunting (_)Fishing (_)Guns in General
What magazines do you read?
(_)National Enquirer (_)TV Guide (_)Globe
(_)Soap Opera Digest (_)Guns n' Ammo
(_)Bassmasters
Preferred method of gambling:
(_)Poker (_)Slots (_)Keno (_)Scratch & Win
What things to enjoy collecting?
(_)Guns (_)Tobacco (_)Fish hooks
(_)Worms (_)Bottle caps
What is your favorite TV show?
(_)Andy Griffith (_)Three Stooges
(_)Dukes of Hazard (_)Beverly Hillbillies
(_)The Man Show (_)Don't have a TV
Who is your current idol?
(_)Earl Scruggs (_)John Denver
(_)Bob Dylan (_)Garth Brooks
(_)Bruce Springsteen
Color of teeth:
(_)Gold (_)Brown (_)Goldish-Brown (_)Black
Where to you get tobacco products?
(_)Convenience Store (_)Pawn Shop
(_)Homegrown
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