Full Name:

Email:

Contact Number:

Can you receive texts at this number?

YesNo

Home City:

Have we already met?

YesNo

How old are you?

What city do you want to meet in?

Where are we meeting?

IncallOutcallPublic Location

Please provide the location name and address if meeting at your location:

Date of Appointment:

Preferred Time of Appointment:

• Hr

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• :

• Mins

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• AM/PM

  —Please choose an option—AMPM

Type of session:

SocialSensual

Type of encounter:

—Please choose an option—Impression (up to 2hr)Inception (up to 3hr)Introspective (up to 4hr)

Outfit Preference:

—Please choose an option—BoudoirGlamourAu NaturaleProfessionalCasual

Favourite Refreshment:

Preferred Ambiance Music:

Suggestions / Special Requests / Questions

3rd Party Verification Service:

If you are a member of a 3rd party verification service, please provide your member handle here.

Recent Reference #1:

(Must include name, contact info, and website or URL to an active online ad)

Recent Reference #2:

(Must include name, contact info, and website or URL to an active online ad)

Employment Info (if recent references are not available):

Company, Title, Website and LinkedIn info

By submitting this form I understand that I am expected to provide a minimum 24 hours’ notice if I must cancel. If I fail to provide enough notice, I will be responsible for 50% of the amount due for the time which has been set aside for me.

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