Your Chance to Date 'Extra's' Most Eligible Bachelors

If you want to date one of “Extra’s” Most Eligible, here’s your chance! Just fill out the form below, and prove yourself worthy of dating one of our sexy all-American guys. A lucky winner may even be set up on a date with the bachelor of their choice… so if you're single, sexy and looking for love, here's your chance to score a one-of-a-kind man!

Tell us why you are the perfect woman for
"Extra's" Eligible Bachelor!
*required fields
*First Name:
*Last Name:
*Phone: ( )
Alternate Phone: ( )
*Street Address:
Apt # (if applicable):
*Zip Code:
*State or Province:
  *Why are you the perfect woman for "Extra's" Eligible Bachelor? (50 words or less)
  *How will you win our bachelor’s heart?

Show our bachelors exactly what makes you the perfect match.

*Upload a digital photo OR video (Quicktime or Flash):

Click the "Browse" button to find and select the digital photograph file on your computer. We request the videos uploaded be compressed.


Web address of the clip:


Mail in your videos to:

1840 Victory Blvd.
Glendale, CA 91201
Attn: America's Most Eligible Bachelor

Please label the tape with your: name, phone number, and address.

I am over 18 years of age

Please note: Tapes will NOT be returned! Please download and complete this form and include with your tape. Remember, by sending in your tape, you are giving us permission to use your image on the air, but it is not a guarantee that your tape will be used.

All photos and any other materials submitted to producer ("Materials") become the sole and exclusive property of producer and cannot be returned at any time. By submitting Materials, you agree producer may, but is not obligated to, use the Materials in connection with the show, in any way, in any medium, worldwide, in perpetuity. Further, you warrant all Materials are 100% original and do not violate the right of privacy or publicity of, or constitute a defamation against, any person or entity; that the Materials will not infringe upon or violate the copyright or common law rights or any other rights of any person or entity; that there are and will be no encumbrances, liens, conditions or restrictions whatsoever upon or affecting such Materials; and that you are at least 18 years of age and the person depicted in the Materials. You agree to indemnify producer and broadcaster for all damages and expenses (including reasonable attorney's fees) arising out of any breach or failure of the warranties made herein.