* Required Field

About You

Name: *
Age: *
Race: *
City, State: *

Contact Information

Email: *
Phone # (No VoiP #'s or Call/Text apps): *
Accept SMS/Text: *

Appointment Details

Preferred Date (Example : 7/16/2022): *
Preferred Time: *
Desired Duration: *
Incall or Outcall:


How would you like to be screened? *
(2) Provider References
Active TER Member
Active USASG Member
Active Ave-X Member
RS2K Verification
Employment Verification
Preferred 411 Invite
Full Payment Upfront

Deposit and Cancellation Policy

I acknowledge that a $00 deposit is required to confirm/secure this booking request. *
I acknowledge that same day appointments may not be canceled. *
I agree that failing to cancel with no less than 24 hour notice will result in forfeiture of my deposit and will require a $200 rebooking fee. *

I am more than happy that you have chosen to spend time with me!  I can assure you, you won't be disappointed.  Please complete this form with ALL of the requested details, this form serves as a proper introduction and will help me determine if our availability is compatible.  Appointment requests lacking the required information will go unanswered.