Name *

First Name

Last Name

Prefered contact method *

Email, Telegram, etc.

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Preferred Date *

Friendly reminder, if it is sooner than 48hrs out, there is an additional rush fee of $500.

MM

DD

YYYY

Checkbox *

1. You understand that I require a discreet non-refundable deposit for all encounters.

2. You understand my rates are non-negotiable.