Name

First Name

Last Name

Subject

Message

Tell me a little bit about yourself and what brings you here. Messages containing explicit language will automatically fail screening and will not receive a reply.

Newsletter Discount Code

Enter the discount code you received in my newsletter to claim your offer.

In which city would you like to meet?

Preferred Date

Which day would you like to meet?

YYYY

Preferred Time

What time would you like to meet?

Hour

Minute

Second

Alternate Dates & Times

In the event your preferred date or time are not available, please provide 2 or more alternate date/time ranges that work for you.

How long would you like to meet?

My place or yours? Please note I do not provide outcall to private residences for new clients.

Incall or outcall?

What type of session are you interested in?

Note: If you choose either of the first 2 options you will be prompted if you would like to add sensual massage. Select "Massage Only" if you want a session which does not include companionship.

Which service do you prefer for deposit?

Please note that gift cards are accepted on a case by case basis and do not apply toward the balance of your session.

Are you interested in a duo?

Where did you hear about me?

Phone

For screening purposes only. I will not call or text you as I prefer to communicate via my encrypted email. No app numbers or Google voice.

Country

(###)

###

####

Employment Information

Please provide me with a reasonable amount of information to verify your employment. For Example: Business website, work email address, business card etc. If you are retiree or unemployed please provide social media.

Cancellation Policy

I have read, understand, and agree to the cancellation policy.

Sweet Hayley Grace