Book Appointment – Miss Yasmine Rose

PERSONAL INFORMATION

Name*

First Last

Age*

City and state of Residence*

Phone Number*

Email*

Preferred Method of Contact?*

Is it ok to text ?

Yes
No

VERIFICATION PROCESS

P411 Handle

TER Handle

Companion References

Please provide the name, email, website and contact number for at least TWO reputable companions you’ve spent time with

1

2

Additional

EMPLOYMENT

Please provide the information below for screening purposes. Please note all information will be deleted after 7 days and is kept CONFIDENTIAL!

Company Name

Position

Work Email

LinkedIn Page

Company Website

Company Phone number

Your Direct Line or Extension

Phone etiquette or cover story to use when calling

Photo ID is required if you are unable to provide references or employment screening. Do you accept ?

Yes
No

File

APPOINTMENT DETAILS

Preferred Date

Preferred time

: HH

MM

Duration

Location Address

Enjoy Spending time with me? Here is a way to get more time and save!

Interested in a package ?

Yes
No

*packages are discounted rates for prepaid dates in advance. You can pay for a certain amount of dates in 1 week, in two weeks and within a month at a cheaper rate than shown.

Package

Package duration

how many dates you would like within the package you chose. You will be emailed the quotation of your choice. I.e 4 1hr dates in a month.

How did you find me?

Is there anything else you’d like to tell me ?

PERSONAL INFORMATION

VERIFICATION PROCESS

Companion References

EMPLOYMENT

APPOINTMENT DETAILS

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