SCREENING FORM

SCREENING FORM
The Basics
Name *

First Name Last Name
Age *
Must be 21+
Email *
example@example.com
Phone Number *
Please do not use VoIP or text apps such as Google Voice
City & State of Residence *

Street Address

Street Address Line 2

City State / Province
I would like a reply via... *

Email Only Text Only Email Preferred, But Text is OK Text Preferred, But Email is OK Either is OK/No Preference
I found you on... *

Tryst.link Twitter Eros Instagram P411 Private Delights Other
Other *
Screening Information
I will be using the following screening method: *

ID Verification Employment Verification Student Verification P411 References
Student Verification

Please provide your student ID and student .edu address below
Student Email *
example@example.edu
Please Provide a Copy of Your Student ID Here *

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Cancel of
ID Verification

Please provide a copy of your unexpired government issued ID in the field below. Driver's licenses, state IDs card and passports are gladly accepted. For your privacy and safety, I recommend that you cover/black out information such as your license/ID number, SSN (if applicable) and your full address. Just your name, birthdate, city/state and picture need be visible.
Please Upload a Copy of Your ID Here *

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Cancel of
References

I only accept references from established independent providers. Agency references will not be accepted. Please provide two recent references from the past six months or three from the past year in the fields below. You must include their names, emails (no phone numbers), websites, ads and/or social media links along with where and approximately when you last saw them (a city and month/year is fine). Applications without this information will be ignored.
Reference #1 *
Reference #2 *
Reference #3
Employment Verification

Please provide at least TWO of the following options.
LinkedIn Or Personal Listing on Your Company's Website
Must have a profile photo and at least 200+ connections
Direct Company Email
yourname@yourcompany.com
Direct Phone Number (include extension if applicable)

Area Code Phone Number
Your Work ID/Badge

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Cancel of
P411 Membership
Your P411 Number *
Additional Screening Information (Optional)

While not mandatory, additional information may expedite and streamline the screening process if available. Examples of helpful supplemental information include links to social media (Facebook, Twitter, Instagram, etc), personal blogs/websites or your Private Delights handle. But again, this is completely optional.
Appointment Details
Where/How Would You Like to Meet? *

Charlotte Another Homebase City (Drive Me To You) Touring City Fly Me To You
Incall or Outcall? *

Incall Outcall TBD
Drive Me To... *

North Carolina Outside of Charlotte or South Carolina (3 Hour Minimum) Savannah GA, Atlanta GA, Athens GA, Augusta GA, Chattanooga TN, Knoxville TN (4 Hour Minimum) Roanoke VA, Richmond VA, Norfolk/Virginia Beach, Charlottesville VA, Macon GA, Nashville TN (6 Hour Minimum)
Fly Me To (The)... *

Northeast (4 Hour Minimum) Southeast (4 Hour Minimum) Midwest (6 Hour Minimum) Northwest (8 Hour Minimum) Southwest (8 Hour Minimum) Alaska, Hawaii, Canada, Mexico or Puerto Rico (Overnight Minimum) Any Other International Destination (48 Hour Minimum)
In Which City and State Shall We Meet? *
When Would You Like to Meet? *

Month Day Year
Please provide at least 24 hours notice
What Time? *

: Hour Minutes AM/PM Option
Length *
Is this date/time flexible? *

Yes No
Please Use This Space to List Alternate Dates and Times
All About You

Use this field to tell me more about you! I'd love to learn more about your favorite movies, books, music, drinks, hobbies, etc. You may also include any particular interests, wardrobe preferences or pertinent health/mobility information (ex: a wheelchair accessible space will be required).
0/1000
Educational Addendums
If you have any areas of study that are of particular interest to you, or you have any particular requests please share here!
Your Favorites & Hobbies
Ex: Favorite books, movies, music, food, drinks, etc
DEPOSIT & CANCELLATION POLICIES *

I understand that a deposit is required, and I have read, understand and accept Gem DeMilo's deposit and cancellation policies.
Should be Empty:

SCREENING FORM

The Basics

Screening Information

Student Verification

ID Verification

References

Employment Verification

P411 Membership

Additional Screening Information (Optional)

Appointment Details

All About You