"Dead Beats" of America, **Submissions:**

PERSONAL INFORMATION --

(DO NOT USE ALL CAPS, PLEASE)
Please answer the following questions completely. Drop-down lists are provided where applicable.

1. Do you have a Homepage?		 Yes	 No 
   if so please put your URL here: 

2. The following are required for posting your dead beat?

   Name:	
   E-mail:	
   City:	
   State:	Select StateAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelewareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirgin IslandsVirginiaWashingtonWest VirginiaWisconsinWyomingOutside USA 

3. Please enter other contact information below: (**NOT REQUIRED FOR POSTING**)

   Title:
   Address:
   Address Line 2:
   City:
   State:			Zip code:
   Phone:
   Other:

---

Dead Beat Information: -- (Information Containing ''**'' is Required for posting)

1. **Dead Beat's Name:	

2. **Known Alias:		

3. **Sex:			 Male  Female 

4. **Date of Birth:		

5. **Location of case:	(2 Letter State Abbr.)

6. Last Known Address:	
   			
   			

---

ADDITIONAL COMENTS --

(DO NOT USE ALL CAPS, PLEASE)
Discription:  Enter as much discriptive information as possible (i.e. Habits,
              favorite color, favorite drink, places known to frequent, jobs, 
              hangouts, known associates, education, smoker/non-smoker, etc.).

1. Height:				2. Weight:
3. Hair Color:		Pick One Black Blonde Brown Gray Red White Other:		(3) If Other:
4. Eye Color:		Pick One Blue Brown Black Green Gray Violet Other		(4) If Other
5. Race:		Pick One Asian Black Caucasion Hispanic Indian Oriental Other		(5) If Other
6. Build:
7. Scars / Tattoos:
8. Other:		Other Dead Beat Info:
9. Your Story:		Your Story Here

---

FORM SUBMISSION

Thank you for taking the time to answer the questions completely.
Please check your submission for accuracy before you hit the submit button.
To add a photograph, use the e-mail address on the confirmation page.
Photographs should be in either; *.JPG, *.GIF, *.BMP, or *.TIF format. (JPG preferred)

Rate this page along with your submission: (** Optional)
bad poor average fair good excellent
Was this Web site.................
Informative Somewhat informative Not Informative Needs Work

Check your submission before clicking Submit,

PRESS ONCE ONLY, PLEASE
If error, please contact me via e-mail, Thanks