Booking Form

Full Name *

First Name Last Name

Age *

Phone Number *

Area Code Phone Number

Give a time when it is appropriate to call. I will ONLY dial during those designated times.

Is texting okay?

YES NO Only on the day of our appointment

E-mail *

Location (City/State or County/Country) *

I'm newbie friendly, so I'm giving three options:

1) Two reputable provider references 2) Verification Site Membership 3) Employment Verification.

For us to meet, you have to submit one out of the three options. That way, you have some degree of flexibility on what you'd like to share.

Provider Reference #1

Enter the provider's name, e-mail, and time/place you met

Provider Reference #2

Enter the provicer's name, e-mail, and time/place you met

Verification Memberships (ie: P411, Date Check, RS2K

If you do not have a verification membership enter "No membership".

Occupation/Job Title

Work Phone Number

Area Code Phone Number

Now on to the fun part! For the fastest response, fill in as much as possible. :-)

Appointment Length *

Desired Appointment Date *

- Month - Day Year

at

: Hour Minutes AM/PM Option Date Picker Icon

Incall or Outcall? *

Outcall Incall

Outcall Location

Enter the message as it's shown *