* Required Field

About You

Contact Information

Appointment Details

References

Please be sure to fill out all fields. Take your time! This will ensure a speedy screening process that will bring us closer to our blissful encounter! If you do not have reference information, please provide the following information:

1. Provide your Full Name, Current Age, your HOMETOWN just as it appears on your ID, which you will show me when we meet

2. Employer, Occupation, and Please provide a verifiable work number. Discretion and privacy is always assured. A deposit may be required.

 

 OR

 

P411, TER or Date-Check Handle.

Any requests made without proper verification information included will be ignored.

NEW TO DATE-CHECK? BECOME A MEMBER HERE BY CLICKING HERE

 

Confidential Verification Request:

Name *
 
Prefix
 
First *
 
Last *
 
Suffix
 
Email *
 
Confirm *
City/State Of Desired Appointment *
 
Age *
 
Ethnicity
 
Phone (Only used for day of appointment contact, unless otherwise discussed) *

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Requested Date *

MM
/
DD
/
YYYY
 
Requested Time *

HH
:
MM
 
AM/PM
 
Location Preference *
 
Session Duration *
 
Preferred Method Of Verification *
 P411 
 Date-Check 
 TER (min. 3 reviews posted) 
 Provider Reference (min. 2) 
 Employment (Website, #, email & ID required) 
 
 
Please Include Verification Details Here:  P411:
 
Date-Check:
 
TER Handle:
 
*Provider Reference Information (if this is your chosen form of verification):  REFERENCE #1: Her name, website, TER ID, date of meeting, & something that may spark her memory of you:
 
REFERENCE #2: Her name, website, TER ID, date of meeting, & something that may spark her memory of you:
 
Employment info (if this is your chosen form of verification):
All fields must be completed. In some cases a photo of your work badge/State issued ID may be required.
Company Name
All fields must be completed. In some cases a photo of your work badge/State issued ID may be required.
Work #
All fields must be completed. In some cases a photo of your work badge/State issued ID may be required.
Website
All fields must be completed. In some cases a photo of your work badge/State issued ID may be required.
LinkedIn (if applicable)
All fields must be completed. In some cases a photo of your work badge/State issued ID may be required.
Photo (optional)
 
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The screening process is a crucial as it establishes a threshold for any future encounters. Only serious and respectful inquires will be considered. If you choose to forego I understand and thank you for your interest.