Name *

First Name

Last Name

What day would you like to meet? *

Check my calendar for availability/location.

MM

DD

YYYY

What time would you like to meet? *

Hour

Minute

Second

AM PM

Upgrades

Add GFE (Additional $100)

Fetish request - subject to approval (Additional $100)

What is your preferred method of screening? *

Choose what options works best for you.

(2) Provider References - You must provide the name, phone #, email and website address for TWO references upon request.

TER Whitelist - Must be whitelisted on TER and posted a review within the past 6 monthes. Please be ready to provide your TER handle and submit a verification message upon request upon requestAdditional verification may be requested.

Preferred 411 - Must have at least 2 okay's within the past 6 months. Additional verification may be requested.

Employment Verification - Must provide your company's name, company email, company phone w/ your direct ext., a photo of your current employment ID/Badge or business card and a selfie of you holding the ID or card

ID Verification - You must provide a (close-up) photo of your State/Gov't Issued ID. I will also need a photo of you holding the ID next to your face. You may take proper precautions to redact your ID #, and address but your full name, DOB, city of residence and expiration date must be visible.

Please read my protocols and policies before moving forward *

You agree that you have read and understand my protocols and policies. By submitting this form, you are agreeing to the terms of my policies.