About you
Full Name
*
First Name
Last Name
City and state of residence
*
Cell phone number (no Google Voice or “burners,” please)
*
-
Area Code
Phone Number
E-mail
*
Age
*
Height
*
Under 5’0”
5’0”
5’1”
5’2”
5’3”
5’4”
5’5”
5’6”
5’7”
5’8”
5’9”
5’10”
5’11”
6’0”
6’1”
6’2”
6’3”
6’4”
6’5”
6’6”
6’7”
6’8”
6’9”
6’10”
6’11”
7’0”
Over 7’
Weight
*
Under 100lbs
100-110
111-120
121-130
131-140
141-150
151-160
161-170
171-180
181-190
191-200
201-210
211-220
221-230
231-240
241-250
251-260
261-270
271-280
281-290
291-300
Over 300
Ethnicity
*
Occupation
*
Where did you find me?
*
Our meeting
Appointment type
*
Companionship
Fetish/Kink/BDSM
Bring me to you
Preferred date
*
-
Month
-
Day
Year
Date
Preferred time
*
12pm (outcall only)
12:30pm (outcall only)
1pm (outcall only)
1:30pm (outcall only)
2pm (outcall only)
2:30pm (outcall only)
3pm (outcall only)
3:30pm (outcall only)
4pm
4:30pm
5pm
5:30pm
6pm
6:30pm
7pm
7:30pm
8pm
8:30pm
9pm
9:30pm
10pm
10:30pm
11pm
Duration
*
1 hour
90 minutes
2 hours
3 hours
4 hours
6 hours
12 hours (overnight)
24 hours
Multi-day
Location
*
References/site memberships
Incall/outcall
*
Incall
Outcall
Doesn’t matter
Review site handles (type “none” if not a member)
*
P411 ID (type “none” if not a member)
*
References (name, email address, date of most recent meeting)
Alternate screening
If you do not have two references from within the past six months, please include TWO of the following options:
Government-issued ID
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Business card
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Work ID badge
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Union card/professional license
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Passport
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Policy agreements
Please initial next to each option to indicate that you have reviewed and agree to abide by each of my policies.
Cancellation policy
*
Deposit policy
*
No review policy
*
Please verify that you are human
*
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