Natural Hair Color:
[x] Brown - $10.00
[] Blonde - $7.50
[] Black - $1.50
[] Bald - $0.50
[] Other - $5.00

Eye Color:
[] Brown - $5.00
[] Green - $10.00
[x] Blue - $15.00
[] Hazel - $7.50
[] Other - $1.50

Height:
[] Over 7' - $20.00
[] 6'8" to 7' - $17.50
[] 6'0" to 6'7" - $15.00
[x] 5'4" to 5'10" - $8.50
[] Under 5'4" - $9.50

Age:
[] 50 to 60 - $17.50
[] 46 to 50 - $15.00
[] 41 to 45 - $12.50
[] 31 to 40 - $10.00
[] 26 to 30 - $7.50
[x] 21 to 25 - $5.00
[] 19 to 20 - $2.50
[] 0 to 18 - $10.00

Birth Order:
[] Twins or more than twins - $75.00
[] First born - $32.00
[] Only child - $25.00
[] Second born - $15.00
[x] Middle Child - $10.00
[] Last born - $10.00
[] Third Born - $55.00
[] Fourth born - $30.00
[] Fifth born - $40.00
[] Sixth born - $21.50

Drink:
[] I did like once - $40.00
[] Only holidays or occasions - $25.00
[] Sometimes - $21.50
[x] YES - $20.00
[] Only weekends - $30.00
[] Every other day - $5.00
[] Once a day - $1.50
[] I live from the bottle - $Bankrupt$ [[back to $ZERO]]
[] No - $60.00

Vision:
[] Perfect vision - $40.00
[x] need/have glasses/contacts but don't wear them - $20.00
[] No correction - $10.00
[] Glasses - $5.00
[] Contacts - $2.50
[] Surgical Correction - $10.00

Shoe Size:
[] 13+ - $30.00
[] 12 and a half to 13 - $25.00
[] 11 to 12 - $40.00
[x] 7 to 10 - $50.00
[] Under 7 - $45.00

Favorite Colors (two):
[x] Green - $75.00
[] Red - $60.00
[] Black - $10.00
[] Yellow - $47.50
[] Brown - $30.00
[x] Purple - $22.50
[] White - $40.00
[] Aqua - $35.00
[] Orange - $30.00
[] Blue - $30.00
[] Pink - $10.00
[] Other - $50.00

Letter Your Middle Name(s) start with:
[] a-f - $5.00
[x] g-k - $17.50
[] l-p - $30.00
[] q-u - $35.00
[] v-z - $25.00

Bedroom walls - select all that apply!*
[x] white - $11.00
[] Green - $33.00
[] Black - $11.00
[] Purple - $22.00
[] orange/red/yellow - $33.00
[] Blue - $22.00
[] other - $35.00

First Letter of the Last Person You Talked To:
[x] a,b,c,d,e,f,g,h,i - $10.00
[] j,k,l,m,n,o,p,q,r - $5.00
[] s,t,u,v,w,x,y - $20.00
[] z - $25.00

Did you use a calculator to add all this up?
[] yes - $0
[] Nope - $100.00
[x] Some - $75.00

Final Total:

Re-Post as "I Cost $____________ a Night"