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Reservation form
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Reservation form
Reservation form
Personal Information
Please provide personal details
ARE YOU VERIFIED ?
*
No
Yes
FIRST AND LAST NAME :
*
EMAIL :
*
RESIDENT CITY AND STATE :
*
AGE :
*
CONTACT NUMBER :
*
UPLOAD YOUR FACE PIC
*
Drop a file here or click to upload
Choose File
Maximum upload size: 10MB
IS IT OKAY TO LEAVE A VOICEMAIL AND/OR SEND A TEXT ?
Yes, either is ok
Voicemail only
Text only
Neither
PREFERRED METHOD OF CONTACT ?
Email
Phone
No Preference
Online Screening Service
If you are a member of one of the following screening services, please provide the necessary details i need to verify you.
PREFERRED 411 :
ROOM SERVICE 2000 :
TER USERNAME :
Companion References
Please provide the name, email, website address and contact number of at least two reputable companion you spent time with.
REFERENCE 1 :
REFERENCE 2 :
Employment Information
Please provide employment details below for screening purposes.
OCCUPATION
*
COMPANY NAME :
POSITION/TITLE :
COMPANY WEBSITE :
MAIN COMPANY PHONE NUMBER :
YOUR DIRECT LINE OR EXTENSION :
PHONE ETIQUETTE OR COVER STORY TO USE WHEN CALLING ?
Appointment Details
Please outline your appointment preferences below.
PREFERRED DATE :
*
PREFERRED TIME :
*
12
1
2
3
4
5
6
7
8
9
10
11
:
00
30
AM
PM
ALTERNATE DATE AND TIME IF ABOVE IS UNAVAILABLE ?
DURATION :
30 minutes
45 minutes
1 hour
1.5 hours
2 hours
2.5 hours
3 hours
3.5 hours
4 hours
4.5 hours
5 hours
5.5 hours
6 hours
LOCATION ADDRESS :
*
HOW DID YOU FIND ME ?
IS THERE ANYTHING ELSE YOU WOULD LIKE TO TELL ME ?
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If you are human, leave this field blank.
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