Session Request Form for Dominique Delirium

Session Request Form

Dominique Delirium
Full name that you would like used

First NameLast Name
Contact Number
Please enter a valid phone number.
Email Address
example@example.com
What date and time work best for you?*
Where would you like to see me?

Hotel near the StripHotel Incall touringResidenceSanctuary Studios LAX
I need the address if you have selected a hotel or a residence

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
What is your preferred method of communication?

EmailPhoneTextAlternative
What type of session are you interested in?
How long of a session are you looking for?
Verification process. Please select which way you would like to be verified.

ID VerificationEmploymentReferences
ID Verification option

Cancelof
Employment Verification option include your company website with your photo or your linked in
References option include a reference from another Dominant that you have seen.
$50 Deposit required and paid before our time together is secured

Cashapp $dominiquedeliriumVenmo @dominique-deliriumOther discussed via email
Tell me a bit about yourself.
Tell me the fantasy you had in mind for this session. Include activities that you want to do, how you would like me to act, key phrases you would like to hear or actions that you hope I will do. Keep in mind, I cannot fulfill your fantasy if I don't know what you want.
Anything else you would like to tell me?
By hitting SUBMIT you are aware that Dominique Delirium is not providing an illegal service of any kind.
Should be Empty: