Appointment Request Form

Booking Request Form

The only thing standing between you and one hell of a good time.
Getting Acquainted
Hi, darling. What's your full name?*

First NameLast Name
Phone Number*
I will not contact you via this number without your permission.
Email Address*
example@example.com
Tell me a little bit about yourself
The types of things I'd love to know: Is this your first time booking a provider? What is your previous experience with kink? Do you have any restaurants or hotels in mind? Please refrain from asking any explicit questions about my offerings.
Our Date
What type of experience do you seek? (Select all that apply)*

GFEKinkDuo DateCouple (+$400/hr)
When would you like to meet?*

MonthDayYear
Date
Please provide a second option, just in case.

MonthDayYear
Date
Where would you like to meet?*
Neighborhood (if applicable), City, State
How long would you like to meet for?*
What are your windows of availability on your requested days?*
Example: Monday 11am-3pm, 7pm-10pm; Tuesday 12pm-11pm
Your place or mine?*

Incall (Julia's hotel room or dungeon, +$300)Outcall (Your hotel room)
What experience do you seek?*
How would you describe yourself in relation to kink?*

VanillaCuriousA dabblerMasochistSubmissiveFetishistOther
Screening
Select a screening method*

Work Verification (completed LinkedIn page + selfie w/ driver's license)Two Provider References (seen within the past year)
Link to your completed (+200 connections) LinkedIn profile, or company website with headshot*
Upload a legible, high resolution, SELFIE of you holding your government-issued ID. Alternately, you may email it directly to ladyflowerbomb@protonmail.com

Cancelof
Provider References: List the names, email addresses, and websites of TWO providers you have seen within the past 12 months.*
Provider Reference #1*
Provider Reference #2*
For The Marketing Department

(It's me. I'm the marketing department.)
How did you find me?*
What made you decide to book me?*
Something you read on my ad or website? A joke on my twitter? Simply good old fashioned physical attraction?
Would you like to be subscribed to my monthly newsletter to receive updates, tour announcements, and exclusive discounts?*

YesNo
Should be Empty:

Booking Request Form

Getting Acquainted

Our Date

Screening

For The Marketing Department