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Who do you wish to see? If you have a second, third,,, choice list them as well.
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*What type of meeting do you want?<br>
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*Meeting Location: place, City, state<br>
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*Meeting Date and Time<br>
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*Length of time of our appointment<br>
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*First Name<br>
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*Last Name<br>
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*Birth Date 00/00/0000 <br>
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*Primary Phone
<br>
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*Work Phone<br>
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*Home City and State<br>
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*Email Address<br>
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*Your height and weight<br>
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*your hair and eye color?<br>
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*Occupation<br>
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*Name of employer<br>
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*Employer City and State<br>
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Employer Website please post full URL including http://
<br>
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*Contact Instructions: How would you like us to contact you? Do you want us to use a cover story? EG: Hi, I am (code name you list) I am (your name)'s insurance agent needing to talk to (your name)<br>
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*Provider Reference 1 Name: <br>
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*Provider Reference 1: Location City,State <br>
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*Provider Reference 1 website: Please include full url include http:// <br>
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*Provider Reference 1 Email address <br>
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*Provider Reference 1 Phone Number <br>
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*Provider Reference 1: Meeting Date(s) to help refresh her memory <br>
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*Provider Reference 1: additional info (name she knows you by, special circumstances, etc....)<br>
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*Provider Reference 2 Name:<br>
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*Provider Reference 2: Location City,State <br>
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*Provider Reference 2 website: Please include full url include http:// <br>
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*Provider Reference 2 Email address <br> (
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*Provider Reference 2 Phone Number <br>
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*Provider Reference 2 Meeting Date(s) to help refresh her memory: <br>
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*Provider Reference 2: additional info (name she knows you by, special circumstances, etc....)<br>
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*Were we referred to you by a client or did you find us online? ?<br>
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The Erotic Review TER
Big Doggie TBD
Room Service 2000
Google
Yahoo
other Board
other Search Engine
Other
Client
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TBD Username?<br>
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TER username<br>
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Room Service 2000?<br>
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Check here if you are a Fantasy Member<br>
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Yes I am a Fantasy Member
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If you were referred by a client or found us some other way please list it here. If you found us on a site not listed please put in the full url <br>
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*I have read the Rules and agree to abide by them.
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