Form

I’m genuinely excited to connect!

To request a date, please:

Fill out my form below or
Send me an email. Click here for details on what to include.

All information will be kept private and deleted after successful verification.

Name*

First NameLast Name

Phone Number*

I will never reach out here unless authorized.

Email *

Please check your spam folder for my response, just in case. Thank you!

Location of our date (City, State)*

How long would you like our date to last?*

Please specify (e.g., 3 days, 4 days, one week)

When would you like our date to be?*

Which day works best for you to meet?*

What time would you prefer?*

Hour Minutes

AM/PM Option

Please share your available days and times for our date.*

Would you prefer Incall or Outcall?*

Please share any necessary access information (e.g., gated/non-gated, parking details, etc). Thank you.

What’s your preferred method for sending the deposit?*

You’re almost there! I’d love to hear a bit about you. Is there anything you’d like me to know, or anything you’d like to share about our date?

Screening Choice (Required):*

Upload a Photo of Your Government-Issued ID*

Upload a Selfie Holding the Same ID*

Your LinkedIn profile must have 250+ connections and a profile photo.

LinkedIn Profile Link or Company Bio Link*

Please provide a minimum of two references from Independent Companions you've seen in the last 6-12 months. Include their names, websites, and emails. Phone numbers are optional but helpful.

I will reach out to the companions directly, which may cause a delay in the screening process.

Please note I do not accept agency references.

Name  Companion name* .
Website   Website Link* .
EmailEmail* .
Optional - Phone #:   Phone Number

Name  Companion name* .
Website   Website Link* .
Email Email* .
Optional - Phone #:   Phone Number

Optional; you may leave this blank.

Add an additional reference.

Name Companion name
Website Website Link
Email Email
Optional - Phone #: Phone Number

You acknowledge that you have reviewed my website and understand that a 20% deposit (50% for FMTY) is required to help prevent no-shows and mitigate associated risks.*

Yes (Must be checked off to submit)