screening

Companionship Request

Hello, you’re one step closer!
Thank you for your interest, I look forward to meeting you!

Please provide the details requested below to schedule your appointment.

Safety is extremely important to me, so honesty and transparency are necessary for me to feel comfortable with you and vise versa; please keep this in mind when completing the form.

Discretion is required and I hold all information provided to me in the strictest confidence. In keeping with my desire to protect your privacy, this form is secure using HTTPS/SSL technology to encrypt your data. This prevents your personal details from being visible to a third-party.

Your screening form will be sent directly to my password-protected phone, and I will respond shortly.

Thanks, see you soon!
Name*

FirstLast
Physical Description*
Age, Race, Height, Hair/Eye Color, Build, describe yourself
E-mail*
example@example.com
Phone Number*

Area CodePhone Number
OK to Call?*

Yes, anytimeYes, at pre-arranged timeNo, never
Accept Text Messages?*
Local or visiting?*
City, State
Job Title/Industry*
What do you do for a living?
Verification Site ID/Profile Name*
P411, RS2K, PD, ECCIE etc Used as reference. If none you must send ID photo (you may block address).
Most recent reference*
The name, number, email, site profile etc of your most recent encounter
Where Did You Obtain My Contact Info?*
References
The handle, email or number of anyone you've previously seen that you would like to use for verification.
About Our Time Together...
Where Are We Meeting?*
What City?*
Length of Engagement*
Longer than 4 hrs?
Please specify desired amount of time
Where shall we meet?*

Outcall (Your hotel or elsewhere)Home Outcall (Your Residence)Incall (My location)
Hotel Name/Outcall Address*
Special request
24 Hr Notice Required

No same-day engagements unless I sent you this form
When shall we meet?*

MonthDayYearHourMinutesAM/PM Option
Anything You'd Like Me To Know?*
Likes, dislikes, questions, special requests
Human Checker*
Should be Empty:

Companionship Request

About Our Time Together...

24 Hr Notice Required