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Nicole’s Appointment Request Form
1
Before we begin
*
This field is required babe!
By submitting this form, you confirm that you are 21 years of age or older and requesting time for companionship only. No illegal activities are discussed or provided.
I agree
I disagree (by disagreeing you understand that your form will be automatically discarded)
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2
Name
*
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First Name
Last Name
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3
*
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Are you currently employed by, affiliated with, or acting on behalf of law enforcement or any government agency, Including any PI related activities? Do you have a badge number?
Yes
No
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4
Are you affiliated with the police or any undercover law enforcement agencies? Or are you involved in any undercover sting operations or any PI related activities? Do you have a badge number?
*
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Please Select
Yes
No
Military Affiliation
Please Select
Please Select
Yes
No
Military Affiliation
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5
How old are you?
You must be 21+ years of age or older.
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6
What is your phone number?
BURNER/VOIP numbers or iCloud emails — I will automatically discard your booking form!
Area Code
Phone Number
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7
If you prefer to be contacted on telegram please leave your telegram username below
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8
Which platform did you find me on?
Please Select
Instagram
X (Formerly known as Twitter)
Tryst
Onlyfans
Telegram
Discord
Referral
ListCrawler
Escort alligator
Escort Babylon
Mega Personals
Private Delights
Other
Please Select
Please Select
Instagram
X (Formerly known as Twitter)
Tryst
Onlyfans
Telegram
Discord
Referral
ListCrawler
Escort alligator
Escort Babylon
Mega Personals
Private Delights
Other
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9
If you found me on one of my many social media platforms, what is your username/handle?
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10
Client Etiquette & Expectations
*
This field is required babe!
I value respectful, relaxed, and enjoyable appointments. To make sure we both have a great experience, I kindly ask that you arrive on time, communicate clearly, and come freshly groomed. Kindness and mutual respect go a long way. If at any point expectations aren’t aligned, I reserve the right to end the appointment early to keep things comfortable and positive for everyone Do you understand and Agree?
YES
NO
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11
What is the city and state you are seeking to book in?
*Please check my Telegram Channel for Tour updates
Please Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Please Select
Please Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Please list the state
Please list the city
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12
Are you just traveling into town?
I love building long lasting connections 🥂
YES
NO
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13
Are you seeking for me to travel to you?
A deposit is required if I travel to you (No Exceptions - Failure to submit deposit when dates are confirmed will result in cancellation/blocking). If you are seeking a “FMTY” — a 20% deposit is required!
Outcall (Deposit Required)
Incall
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14
What is the duration of time you would like to spend together?
Please Select
Hhr
Hr
12 hours or more
Other amount (will discuss upon contact)
Please Select
Please Select
Hhr
Hr
12 hours or more
Other amount (will discuss upon contact)
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15
What is the industry you currently work in?
Please Select
Agriculture
Construction
Education
Engineering
Finance
Healthcare
Information Technology
Insurance
Manufacturing
Mining
Real Estate
Retail
Transportation
Utilities
Wholesale
Other
Please Select
Please Select
Agriculture
Construction
Education
Engineering
Finance
Healthcare
Information Technology
Insurance
Manufacturing
Mining
Real Estate
Retail
Transportation
Utilities
Wholesale
Other
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16
Please Review: If I travel to you — a $50 deposit is required if I have to travel to you. If you are unable to send a deposit prior to our session, you will be blacklisted.
All deposits apply towards total session. Deposits can be paid via Cashapp, Apple Pay, Zelle, and Venmo.
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2
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I understand 🥂
I do not understand 🤔
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17
Appointment Time
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18
Is there anything you would like to share to help me better prepare for our time together? I appreciate your honesty and for sharing anything sensitive with me. This is a 100% judgement free zone.
Feel free to ask questions or special requests such as outfits, music, or accommodations.
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Ok
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19
Video verification is required for any and all bookings. Which platform would better work for you to meet via video?
Live video verification gives us the chance to say a quick hello!
Please Select
FaceTime
Google Meets (Duo)
Instagram
Telegram
Discord
Other — A link for video chat can be shared with you via FaceTime or Google Meets (Duo). If this option is selected, I will share a link with you to complete the video verification.
Please Select
Please Select
FaceTime
Google Meets (Duo)
Instagram
Telegram
Discord
Other — A link for video chat can be shared with you via FaceTime or Google Meets (Duo). If this option is selected, I will share a link with you to complete the video verification.
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20
Client Verification.
*
This field is required babe!
To proceed with your appointment request, please upload a clear photo of yourself holding up four fingers. This is a standard verification step to ensure discretion, safety, and a seamless experience.
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Select files to upload
Max. file size
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Please make sure your face is visible. No sunglasses or filters.
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21
Client Verification
*
This field is required babe!
To proceed with your appointment request, please upload a clear photo of yourself holding up four fingers. Please make sure your face is visible. No sunglasses or filters
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22
Appointment Confirmation
After submitting this form, please send a brief text with your name to confirm your request. Incomplete submissions will not be reviewed. 909-682-6230 telegram @RealxTrophy
I understand
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