Massage Request Form

Please fill this out completely. Any incomplete or falsified information will be seen as an act of ill will and deceptive intent and will be handled accordingly.

The following information must be real information or the appointment will be refused and you will be denied future appointments.

Required information

WHEN: Date and time requested for appointment: _____________________

See calendar for possible availability. There are no guarantees of availability based on the calendar. It is only a guideline and not an exact, updated schedule.

I rarely have last minute or same day appointments available for VIP clients. This means that I DO NOT HAVE any last minute or same day appointment for UNKNOWN people.

WHERE: You are requesting an appointment at which location:

____My incall location (location given after approval of appointment)

____Your outcall location (if hotel location, please also provide your city of residence). Please provide address of hotel or for housecalls, intersection closest to residence. Specific address or hotel room number will be requested later._____________________________________________________

WHO: Full Name _______________________________________________

Month and Year of birth: __________________.

I will not work on anyone under the age of 28. No exceptions.

Email _____________________________________________________

This email will be used to identify and confirm your account in the future and send future mailings to. Please use a private email that you will remember and be able to access in the future. I cannot help you if you forget what the email was or can no longer get access to that email and you will have to start all over again like a brand new client.

Phone number to establish new accounts: ______________________

I do NOT accept burner or VOIP numbers. You will be banned from my office if you lie about this.

Optional information

Best phone number to reach you in case of last minute schedule conflicts or delays if different:_________________________________________________________

Best method for future contact when exclusive promotional specials or “flash sale” appointments are made available for VIP members; Call or text number or email: ______________________________

I will check ID to confirm identity. Deliberate attempt to deceive me will be regarded as an act of malintent and ill will. Your appointment will be cancelled upon discovery and your deposit will be forfeited since I will have no way of knowing who actually sent it.

By submitting this information you verify and agree that you:

___are over 21 years of age

___are the person whose identity and information you have presented

___understand that any deception about your identity will result in a forfeiture of your deposit for reservation of appointment