Booking Form

My booking form is designed to book and screen in a single step. Most screening fields are mandatory as the available information varies from one person to the other. If you fail to provide me with sufficient screening details, you may be required to provide a deposit or be refused service altogether.

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Contact information

Name *

First

Last

Preferred method of communication *

• Text
• Email

Phone *

Email *

Scheduling

Extra extra discretion required? (Married, executive, famous etc) *

• Yes.
• No.

Preferred date / time *

Date

Time

Preferred date / time (2nd choice)

Date

Time

Desired duration *30min (incall only)30min (incall only)1 hour1.5 hours2 hours3 hours

Location *IncallOutcall

Specify… *HotelResidential

Hotel / Adress / Intersection *

Which hotel? Don’t forget to specify which location especially for large chain hotels. If residential, address or nearest intersection.

Upload proof of address

Click or drag a file to this area to upload.

License, utility bill… whatever has your name and address on it and is recent.

Screening

A deposit will be required if I do not have enough information to screen adequately.

Provider References *

• Yes.
• No.

Do you have a reference from a reputable provider you’ve met with in the last 6 months?

Reference information

MERB Handle (if applicable)

Twitter Handle (if applicable)

LinkedIn URL (if applicable)

A little bit about you…

Is this your first time? *

• Yes.
• No.

Age *20s30s40s50s60s70+

Tell me a little bit about yourself.

Upload a selfie

Click or drag a file to this area to upload.

If not uploaded here, I will ask for it via email or text.

A little *more* about you…

Turn ons(s)

Turn off(s)

Dealbreaker(s)

Anything else you would like to share?

AGE OF MAJORITY *

• I confirm that I am at least 21 years of age.

CONFIRM RATES *

• I confirm I have read the information available on the site including the rates, which are 400h in the daytime and 500h at nighttime or for outcalls.

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