Pre-Screen Form ..
Note: Please check your spam if you get no response within 24 hours.
Deposit Note:
As time is something we can never get back, a deposit is required after you are screened and cleared. This is noted on my ads & website. It is certainly your choice to move onto someone else who is more in line with a screening/deposit process you are comfortable with. I totally understand and would not wish to waste your time.
Name ( No Aliases Please )
*
First Name
Last Name
Age
*
Height/Weight
*
Ethnicity
*
Please Select
Black
White
Asian
Hispanic
Other
Email
*
example@example.com
Phone Number
*
Please do not submit VOIP numbers
Preferred Method of contact
Email
Text
Call
(2- 3) Provider References (email addresses)
The contact emails of 2 - 3 Provider references you have seen in the last 6 months. No Phone numbers please
Hobby Handle
Preferred411, TER, OH2, RS2K, Private Delights
Industry/Field of work (even if retired)
*
Employment Info
Facebook / Linkedin link
City/State of Appointment
*
Where did you find me
I understand that a deposit is required to book our time together
*
yes
I have read and understand the deposit/cancellation policy
*
yes
Submit
Should be Empty: