Andrea's Alternate Screening Form
Name
First Name
Last Name
Email
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Age
Preferred method of contact
Email
Phone call
Text
No Preference
Appointment Details
Date
-
Month
-
Day
Year
Date
Time
Hour Minutes
AM
PM
AM/PM Option
Alternative Time if Above is unavailable
Outcall Location
Appointment Type
GFE- Companionship
Kings Massage
Nuru Plus
Milking Table
Kings Milking
The Ultimate Milking
The Seductive Touch
Dinner or Lunch Date
Length of Appointment
Minimum 1 HR or more. Please see appointment type details for minimums
Screening Information
Provider Reference #1:
Please include their website links and contact information.
Provider Reference #2
Please Include the Providers Name, email, Phone number, web address and Link to any advertisement
Private Delights Handle
You must have a minimum of 5 reviews and providers must have commented on your Reviews
Preferred 411 ID
Please send me a message on P411
Board Handles
Tell me a little about yourself
I have read and agreed to the terms of ALT Screening
*
Yes
No
Screening Fee Payment Options ($50)
*
Cash App $LVConsult
E- Gift Card: Target,
E-Gift Card : Amazon
E-Gift Card: Wayfair
E-Gift Card: Southwest Airlines
Submit
Should be Empty: