CONTACT

ARRANGEMENT FORM

When I am not traveling I am available in Las Vegas almost any time with advanced notice, I prefer at least 24 hours as I am going to spend a few hours getting ready for our encounter. However, I may indeed be able to make a same day booking but please leave time for verification. If you do not have references, I will try to verify you through other means, filling out the booking form fully is always the best place to start.

Your Information

Name *

First

Last

Email *

Address

Address Line 1

Address Line 2

City

State

Zip Code

Age *

Cell Phone Number *

Please write me a short personal note *

Includes your desires for our rendezvous (please do not be explicit.)

Date you would like to meet and time you would like me to arrive *

Date

Time

Amount of time you would like to spend with me *

Location of our encounter *

Provider Reference

Name

First

Last

Email

Phone

Website Ad or URL

Second Provider Reference

Name

First

Last

Email

Phone

Website Ad or URL

Verification IDs

Preferred411

RS2K

TER

One final thing

How did you hear about me? *

Email

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