Booking Form

1
Name:* This field is required.
First
Last
2
Email:* This field is required.Be sure this is spelled correctly- I will be contacting you through it.
3
Phone number:* This field is required.Let me know if this number is not okay to text.
4
LinkedIn, workplace name, or P411 username:* This field is required.
5
Birthdate:* This field is required.
Date
Month
Day
Year
6
Requested duration:* This field is required.
Select an option
Select an option
48 hours-9000
24 hours-5000
14 hours-3500
8 hours-2500
6 hours-2200
4 hours-1800
3 hours-1500
2 hours-1300
90 mins-1200
1 hour-1000
7
What did you have in mind for our date?* This field is required.For longer dates social activities/dining should be involved. If you have public discretion concerns please let me know and I'm happy to get creative.
Huge
Large
Normal
Small
Ok
Ok
8
Requested date/time:* This field is required.
Date
Month
Day
Year
1
2
3
4
5
6
7
8
9
10
11
12
Hour
00
15
30
45
Minutes
PM
AM
PM
9
Meeting location:* This field is required.Dates 15+ miles from downtown Austin may have a surcharge.
Select an option
Select an option
Outcall
Incall (+100)
FMTY
10
Specific location:* This field is required.Address, city, hotel name, etc.
11
Tell me a bit about our trip together:* This field is required.
12
How did you find me?* This field is required.
13
Please introduce yourself and leave any comments, details, or requests:* This field is required.
14
Tags
[object Object]
Should be Empty: