Screening Form (USA) All new visitors must schedule 24 hours in advance and is expected to fill out my Screening Form for scheduling. Once I’ve properly screened you I will contact you to confirm your appointment. A contact number also will be provided once you are verified, and have confirmed an appointment. You may send me a follow-up e-mail when you have completed the form. If we have met before, you can send me an e-mail and outline the appointment details (such as the requested date, time, duration, and location). General Information First Name Last Name Age Mobile Number - (No Internet App Numbers) Email What is the best way to get in contact with you? Mobile NumberEmailBoth How did you find out about me? Facebook Profile URL - (Optional) LinkedIn Profile URL - (Optional) Upload a photo of yourself - (No Explicit Photos) Age Verification Upload a valid photo ID (i.e Driver's License, Identification Card, Passport) - Please black everything out EXCEPT your photo, full name & date of birth Appointment Details Date Time Duration 600 - Incall (60 Mins.)800 - Incall (90 Mins.)1000 - Outcall (Upscale Hotels Only + Hotel Verification + Transportation)2000 - Dinner & Dessert (3hrs.)4000 - Overnight (7hrs.)Weekend Getaway + Lodging + TransportationMonthly ArrangementText Buddy Arrangement City State How do you wish to pay the deposit?VenmoPayPalZelleAmazon eGift CardPrepaid Visa Gift Card Is there anything important that I should know? - (Your appointment will be declined if any discussions are pertaining to services) I agree to pay the 50% deposit required to schedule a visit. And the remaining fee will be paid upon arrival.