User Survey for JJ’s Place

Version 3.01

I have seen numerous surveys on the internet on all types of subjects. Some of them are simple surveys where you print out the page and mail the survey in, others are the really fancy professional ones.. This is not one of the fancy surveys. It is just a simple fill out the form and get on with your surfing the net type of form..

Oh yeah, I had better let you know that information you submit will not be loaned, rented, leased, given or sold to any spam list. To take this survey highlight the entire text and then right click and then copy or just hit print. If you copied this you next open your word processor and paste this document into it. Then answer each and every question.

(Please do not submit photographs of screen marked up with magic marker as it will not be accepted. .)

Thank you for taking this survey! Mailing instructions are at the bottom.

General Information

Name (full)
List all Aliases
Address:
DOC #
City:
State:
Zip Code
Phone #: xxx xxx-xxxx
Now enter your real #
Fax #
Cell Phone #
Personal Data	Sex (M/F/O)	Age :	Birth Date :
Physical description	Please include all defects and note the amount and type of exercise you do. Start on line below
Use as much space as is necessary. If not enough room use back of page.

How did you first hear about this web page? ( check all that apply):

Friend:
Relative:
Friendly Relative:
Advertisement:
Banner Ad:
Link Page:
Ransom Note:
News Paper:
Stranger:
Strange Friend:
Really Strange Friend:
First Contact, Human:
Alien Contact:
Other:
Nudie Page
Funny Farm
Presidential Contact
Other Govt. Source
Homeland Insecurity Agency
Spam Mail
Snail Mail
Bathroom Wall

How do you rate the contents of this web site?
Really Good		Great		Excellent		Fantastic		Superb

What did you like best about this web site?

It is the beston the web and you are a great webmaster!

What did you like least about this site?

The following questions are for demographic use only. They will help ascertain the types of people visiting my site and help improve it.

Demographic Information

Real Age:

Is this the truth this time?

Are you sure?

Positive?.

Ok., Initial here

ANSWER HERE

What is the size of the town you live in?
Do you own your own home?
Is it worth over $150,000?
Do you have a basement?
Is it a house or a mobile home?
If you rent do you live in a : (describe)	Description of living quarters including secret entrances/exits
Duplex
House
Condo
Apartment
Mobile Home ?Own Land? In Park?
Card Board Box
Under Bridge [Name of bridge]
Tent [brand]
Car [does it run, where parked]
Hole in the Ground/Cave [location]
Abandoned house/ warehouse
Other. Describe.

ANSWER HERE

Do you have a security system for your home?
What is the brand name?
Do you keep a copy of your access codes where they are easily accessed? Where?
Do you have neighbors that “keep an eye” on your place when you are gone?
Do any of them own guns?
Are any of them Law Enforcement Officials?
Do they own guns? if yes, are they automatic?
Does neighbors own vicious dogs? (describe)
What are the addresses of those neighbors?
(If more space is needed please use back of form.)
How close is your nearest neighbor (feet)
Is your home in a "high crime" area?
How far are you from a fire station? (blocks)
How far are you from a Police Station (blocks)

PETS

ANSWER HERE

Do you have pets? Enter number and name
Cats?
Birds?
Fish?
Dogs?
Are they indoor or outdoor dogs?
What kind of dogs are they?
Have they had all their shots?
Are you insured against dog bites in your house?

( on a scale of one to ten with one being lousy and ten being superb. Circle one only)

How effective would you rate the police department in your town?

1 2 3 4 5 6 7 8 9 10

How would you rate the reaction time of the local police department? ?

1 2 3 4 5 6 7 8 9 10

How would you rate the "corruption factor" of the Courts, how easy are they to bribe?

1 2 3 4 5 6 7 8 9 10

How hard is it for cops to find your house in an emergency?

1 2 3 4 5 6 7 8 9 10

Are the cops in your town considered proficient shots? ( Can they hit the broad side of a barn from inside?)

1 2 3 4 5 6 7 8 9 10

Are the cars fast?

1 2 3 4 5 6 7 8 9 10

Is there an effective 911 system in your town?

1 2 3 4 5 6 7 8 9 10

How good is the food in local Jails?

1 2 3 4 5 6 7 8 9 10

HOBBIES Do you collect (List value of collection in adjacent box) :

Stamps	Rare Coins	Rare Books
Guns	Records	Dolls
Other	Other	Other

Does any of your collections involve a potential health hazard? If so, Describe

ANSWER HERE

What kind of vehicle do you drive?
What is the year and model?
Where do you keep the extra set of keys for it?
How many additional cars do you own?
Do They Run?
Are they on inflated tires , cement blocks, or other?
What are the names of the financial institutions where you bank? List all, along with pass code and routing and account numbers
Please list any Swiss or off shore accounts separately below, including full passwords for each. Include here any other foreign accounts.
Do you have a safety deposit box?
Which of the above institutions is the box located at?
What is the approximate value of the items kept there?
List contents of each box.
Please sign your full name here (as it appears on your checks and other legal documents)

Do you own : Value: What Room is it located in?

Color TV
Stereo System
Microwave
CD Player
Big Screen TV
Cam Corder
Computer list type in last column also
Other High dollar items

ANSWER HERE

Do you live alone?
Are you Female?
Are you a good looking female?
Are you under 38?
Are you over 18?
Do you weigh less than 90 pounds
Do you weigh more that 160 pounds?
Were you born a female?
Have you had a boob job?
Have you had any other cosmetic surgery?
Are you a member of the Military? Which one
Special Forces? Which?
Are you or your other half Mafia?
How high are you ranked?
Do you hold a martial arts belt?
Do you know ANY hand to hand combat techniques?
What are the hours that you work?
Are your hours variable?
Do you often of leave work early?
What Hours does your partner work?
Is your partner's hours variable?
Does your partner often leave work early?
What is your Work address and phone?
What is the name of your supervisor?
What is your partner's work address and phone?
What is the name of partners supervisor?
When are you and your partner most likely to be home?
When are you and your partner out?
Where do you usually go?
When do you go on vacation?
Where are you going this year?
Will you go together?
Would you possibly want company?
How much Cash are you taking with you?
How much cash do you keep in your home?
Where do you keep it?
What is the access code?
If manual, where is key?
What kind of lock do you have on your door?
Do you have any windows that people can not easily see?
Do you own any Firearms?
Do you have wild parties sometimes late at night?
In the last 6 months have police responded to noise complaints at your house? How many times?

place key in other box and trace

Thank you very much for completing and submitting this survey. Please notify me if you have a change in your working hours, if you move, or if you gain or loose a partner as well if your vacation plans change.

After you have completed the above document you need to scan the information into your computer and save it to a file and attach it to an email to me. Or email me for a number you can fax this to.. Thanks again.