| E-mail Address: * |
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| Your Name: * |
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| Your Fiance’s Name: |
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| Date of Your Wedding * |
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| Time of Your Wedding * |
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| Is This time flexible? * |
Yes
No
Possibly |
| What city will your wedding be held? * |
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| How many guests will be at your wedding? * |
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| Home Phone: * |
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| Work Phone: |
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| Cell Number: * |
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| 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: * |
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| Further comments or questions: |
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| * Required |
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