Scheduling and Screening

Scheduling and Screening
Legal First and Last Name *

First Name Last Name
Date of Birth *

Month Day Year
Date
Email *
example@example.com
Registered Phone Number (No Burners) *

Area Code Phone Number
City and State of Residence *
Job Title *
Company *
Company Website *
If none, type none
Memberships & handles *
Aka - RS-Avs.com, P411, Twitter, Private Delights - if none, type none
Provider References? (names & website addresses) *
if you have P411 with recent OK's, o rs-avs.com, or would like to do a work verification, this is not needed If none, type none
Date of our First Meeting *

Month Day Year
Date
Time *

: Hour Minutes AM/PM Option
Location of our first meeting (City and State) *
How long would you like to spend together? *

Dinner Date 3-4 Hours Clockless evening (up to 6 hours) Overnight Extended
Will I be hosting, or will you be hosting? *
Are you willing to send a deposit? *

Yes No
Where did you find me? *

Eros Slixa Tryst P411 Private Delights
Do you like a little feminine perfume? *

Light Perfume Yes! Doesn't Matter Please, no scents
Introduction - something about yourself, so I can get to know you. I do like some correspondence here so I can get a feel for you. *
Should be Empty:

Now create your own JotForm - It's free! Create your own JotForm