| E-mail Address: * | |
| Your Name: * | |
| Your Fiance’s Name: | |
| Date of Your Wedding * | |
| Time of Your Wedding * | |
| Is This time flexible? * | Yes
No
Possibly |
| What city will your wedding be held? * | |
| How many guests will be at your wedding? * | |
| Home Phone: * | |
| Work Phone: | |
| Cell Number: * | |
| When is the best time to contact you? |
Morning
Afternoon
Evening |
| What is the best means to contact you? |
E-mail
Home Phone
Work Phone
Cell Phone |
| I am authorized to issue Marriage Licenses in LA County. Are you interested in this service? | Yes
No |
| How did you hear of us? * |
Personal Referral
Search Engine
Wedding Website
General Website |
| Please provide the specific name from above question: * | |
| Further comments or questions: |
|
|
| |
| * Required | |
