APPOINTMENT REQUEST FORM

Are you a returning client, P411 or RS2K member?

First Name

Last Name

Phone number...If you don't give this to me, DON'T TEXT ON THE DAY OF OUR MEETING PLEASE!.

Email Address (IMPORTANT: Double check for correct spelling)

Okay to call or text? I will try to accommodate your request, but discrection is YOUR responsibility. There are apps available that will give you a secret number that will require a password to use.

Your Age Range

Select a date. If you are flexible, unsure, or just want to be pre-screened, just let me know in the notes at the bottom of the page in the comments section.

Desired Start Time. I'm normally available 11 am to 10 pm 365 days a year. Prebooking is recommended. I'm often not availabe for same day appointments. My tour my schedule is usually full before I arrive.

In call (my place, in call only on tour) or out call (your place) .

Amount of time: There are two payment options: prepay for a discount, or pay cash in person. There is a deposit required with the cash option for everyone on tour, most first time clients in Northern Illinois and Wisconsin, and for meetings longer than 2 hours.

Do you want to prepay for a discounted rate, or pay cash or a deposit plus cash?

Which city do you want to meet in? PLEASE ONLY LIST MAJOR CITES. Select a city on my tour schedule, Chicago, Milwaukee, etc. Don't choose a suburb.

Which screening information will you provide (must choose one)?

What Interests You? (See entertainment ides page). Check all that apply. You can elaborate in the comments. There are special instructions for actvities with an astrik. Ask the booking agent about them!

Traditional GFE

Tantra

*BDSM

*Role Play

Photos and Video

*Bring my significant other

*Multiple female providers

Swingers Club (special rates)

Learn about viagra (over 50)

*Learn about mind-altering experiences (3H minimum)

*Travel with me/fly me to you

*Wardrobe request

COMMENTS: Is there anything else you'd like to tell me? NOTHING LEWD OR SEXUAL, PLEASE.

How many times have you met with a provider?

This is my first time

This is my second time

This is my third time

4 to 7 times

8 to 15 times

16 to 25 times

More than 25 times

Will you help me with advertising by telling me which sites you use when searching for a new provider?

I accept terms & conditions

Thanks for submitting your appointment request. If you don't hear back from me within 72 hours, please contact me. I look forward to seeing you soon!

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One online zoom meeting

APPOINTMENT REQUEST FORM