Reservations

Kindly fill out the form to ensure a time with me. Any information I receive from you will be kept confidential. The reason I screen is for my safety ONLY. Make sure to give me a TRUE verifiable reference, unless you are a member of a verification service, you will need to provide that information in the appointed box. I will get back to you ASAP. Please check your spam folder just in case my email might end up in it.
Serious Inquiries ONLY.

Appointment Date at
Duration of the rendez-vous:

1 hour
90 minutes
2 hours
3 hours
4 hours
4 hour dinner-date package
More Than 4 Hours

12 hours full day or overnight
24 hours full day
Weekend getaway

IF YOU HAVE ANY COMMENTS, CONCERN OR INQUIRIES, PLEASE WRITE ON THE BOX:
  Confidential Information
Location of Appointment
Hotel/Business Name
Address
Name
As it appears on your photo ID
Age
Marital Status: In a Relationship
Single
Divorced
Married /
If married how long? years
Ethnicity
Circumcised? Yes No
My Email
Phone Number
REFERENCE  
Provider's name (No agencies):
Her website/Onlie Ad :
When and where did you see her last?
TER handle, RS2K or P411 or Date-check number(if any):

How did you hear about me?:


I accept www.P411.com client members


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(send your banner exchange request to kimdior@yahoo.com
)

 


TER Online Status