Name of Hotel or Address where we'll be meeting. If I'm flying to you, please also include the city information.

If visiting, what is the nature of your visit?

Preferred hour and length of time for our visit *

NOTE: 25% - 50% deposit required for all travel dates

Required Personal Information***

Please note that all required fields need to be complete in order to schedule a date.

City and State of Residence *

Cell Phone (you WILL NOT be contacted) *

Email*

Age *

Physical Description *

Employment Screening

Please provide your employment information below. Please note, this is only for verification purposes. Discretion is imperative for both parties.

Company Name *

LinkedIn *

Official Position/Title *

Direct Office Line

(this is only to verify your identity, you WILL NOT be contacted) *

Main Number at your Office (must be different from direct line) *

References (of at least 2 other Escorts)

Please provide the information of at least two reputable companions you have spent time with.

Name*

Website*

http://

Email*

When and where did you last meet? *

Name*

Website*

http://

Email*

When and where did you last meet? *

Review, Message & Screening Board Affiliations

Please include the URL and screen names for any screening services or review/message boards you are affiliated with.

Screening websites you are a member of?

Client ID or Screen Name

Review & Message board affiliations?

Screen Name(s)

Deposits

Travel dates require a 20% deposit. Please note, funds will be sent to my administrative business account.

Additional Information

Additional information to help me process your request

Please include any additional information you would like me to know:

Reservation Form

Fill out the form completely for a speedy response