Mr.(name):
age:
Mrs./Ms.(name):
age:
Address:
City
State
Zip Code
Home Phone#:
Home Fax#:
His Work#:
Her Work#:
His Work Fax#:
Her Work Fax#:
Married?
Single?
If married, length of present marriage:
# of Birth Children:
Ages:
# of Adopted Children:
Ages:
Do you have a
homestudy completed or in progress:
Have you filed
an 1600A INS form:
Please discuss
image of child desired:
Gender preferred:
Either
Male
Female
Age:
Ethnicity:
Country:
Other:
Did you see a
specific child(ren) on our site you are interested in?
Name:
LAS File#:
Federal Express
account# (if applicable):
Would you like future documents Fed Ex'd using this account#?
E-mail Address:
By submitting
this application via the Internet you agree to be bound to the above
application and all statements made herein.
