BOOKING FORM
PLEASE COMPLETE THIS ENCRYPTED FORM FOR SCREENING PURPOSES
How did you hear about me?
Google
TER
P411
Slixa
Tryst
SkipTheGames
Eros
Twitter
Switter
OurHome2
PrivateDelights
Adultsearch
Escortdirectory
Other
E-mail
*
example@example.com
Phone Number
*
-
Area Code
Phone Number
Preferred Method of Contact
*
Text
E-mail
Other
Preferred City/Town To Meet
*
Where Would You Like Our Date To Begin?
*
Outcall To Your Upscale Hotel Room
Outcall To Your Private Residence
You Want Me To Reserve An Upscale Hotel Room (Incall)
I'm interested in Fly/Drive Me To You
Other
Requested Date
-
Month
-
Day
Year
Date
Requested Time
*
1
2
3
4
5
6
7
8
9
10
11
12
:
Hour
00
10
20
30
40
50
Minutes
AM
PM
AM/PM Option
Duration
*
60 minutes
90 minutes
2 hours
3 hours
4 hours
8 hours
12 hours
24 hours
Fly Me To You
Coffee Date
Lunch/Dinner Date
Other
Forum Handles (If Applicable)
(i.e. TOB, OH2, PrivateDelights, Tryst, Twitter, P411, etc.)
Please share your physical description (Weight, Height, Age, Ethnicity, Tattoos or Piercing)
*
Screening
This form is securely encrypted and I assure you that your information is never shared, stored, or saved. I use this ONLY for my personal screening purposes. I will let you know once this process is complete, after such, all sensitive information is destroyed.
Screening Option 1 - Provide Two Reputable Companion References
(please be sure these lovely ladies are okay that you use them as a reference and that you have visited them within the past 6 months or sooner)
Reference 1:
First Name
Website
P411 Info
Date Visited
Email
Reference 2:
First Name
Website
P411 Info
Date Visited
Email
Screening Option 2 - Employment Verification
Screening Option 3 - Provide Valid Government Issued Photo Identification
Upload Document
If you have any difficulty with uploading your ID please send the Image to my encrypted email Lyssandra.ash@protonmail.ch - I also suggest sending the email from an encrypted email on your end to keep your personal information safe.
Cancel
of
Screening Option 4 - Send me an appointment request from your P411 account. You must have at least 3 okays, the most recent being within the past 6 months.
Please feel free to tell me more about yourself, ask any questions, or submit specialty requests so I can be sure our upcoming date is everything you hope and more!
Submit
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