* Required Field

About You

Name: *
Age: *
City: *
Ethnicity: *

Contact Information

Email: *
Phone: *
Accept SMS/Text:
Best Times to call: *

Appointment Details

Date of Appointment: *
Location /Hotel: *
Length of Appointment: *
Time of Appointment. Please state am or pm: *
Smoker or Non-smoker: *
Traveler to this Area:
Special Request(s):
Any Likes or Dislikes:


Names and contact info of providers you've seen before, and any forum usernames or handles:
Where did you see my ad? Please let mention where you found me. *

Please send me an email or text after you fill in my contact form for faster response. 702-715-7577