* Required Field

About You

Name: *
Age: *
City: *
Occupation: *
Company: *

Contact Information

Email: *
Phone: *
calls only: *
best time to call-: *

Appointment Details

Preferred Dates/Times: *
Preferred Location: *
Preferred Length: *
Outcall Location:
Special Request(s):
Any Likes or Dislikes:
Are you a resident or traveler:

Screeing is imperative for both our safety. I'm an established and trusted escort companion and will hold all information given with the utmost discretion. Once you leave my company I no longer know you, until you contact me again. All new clients please fill out this form then call.. Any forms with blank, or incomplete information, ie: only a first name, or without photo id attached, will be ignored and then deleted. If you can't or are not wanting to provide all the requested information, then please contact another escort.