Request Form

* Required Field


Have you sent the Amazon $25 screening card? I do not screen until I receive it. *

About You

Photo not required but nice, no dick pics please!
Legal Full AND LAST Name shown on your USA drivers license (if you do not have one - do not continue): *
Year of your birth: *
Do you have P411? If yes list handle & send me a request through site. NOT required to have. *
What is your occupation? *

Cell Phone Confirmation

What is your cell# (must be # you will use at appointment): *
Text 423-609-8553 from the cell phone you will use the day of our session to say you have filled out this request w/your name: *
Is this your personal cell or an app on your cell? *
Can you receive texts anytime? If no, when is safe to text? *

You must have an email and text. If you do not, come back when you do.

Hobby Email (email that your wife does not access!): *
Do you have a work email like that you can use to be screened? *

Appointment Details

How many hours would you like to spend together? Please respect my time & book the correct time you need. I will never leave early, but I can't stay late either! *
Dates available to meet? *
Apx time frame you would like to start? (not before 9AM or after 9PM): *
What city to meet in? *
Incall in Orlando or Outcall - if out, what is the location: *
What session are you looking for? GFE/Fetish or just Fetish? *
Are you going to prepay or use cash w/deposit? *

This is important to check & get correct!

Did you check everything is correct etc. Typos cause lots of requests to just get deleted: *