What is your full birthday? Month/Day/Year, please.
July 19, 1977
How do you describe your "citizenship" status?
Name of your local county.
What State do live on?
Phone number please. This information is kept private. We do not sell your information.
Who referred you? How did you find us?
Why are you here? What is our highest priority today?
What do you think we can do for you?
What are your areas of interest, talent and/or occupation?
Various interests, talents, and occupations.... I can do anything. I am a survivor. Waiting for the benefits and the vacation time to kick in..
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Hi, I have something very vital to disclose to you,.Could you please get back to me on ( email@example.com ) for the details.Thanks.
I sent you my number in your email