Kourtney Chase - Booking Form

* Required Field

Safety Screening REQUIRED

Where did you find me? *

If you chose "Other" where did you find me?

About You

Name: *

Age: *

Relationship Stats: *

Occupation: *

Contact Information

Email: *

Cell Phone (NO TEXT APPS): *

Best Time to Contact you? *

Best Way to Contact You? *

Text

Either

Twitter Username:

Instagram Username:

Private Delights Handle:

TER Handle:

P411 ID:

Booking Details

Preferred Date: *

Preffered Time: *

Amount of Time: *

Incall or Outcall ? *

Special Request(s) / Service Requests:

Safety Screening & Age Verification

Photo of yourself holding up your ID to your face: *

Photo of the front side of your Identification Card or Driver's Licence: *

Photo of a Utility Bill with same name as your ID. This must be the address I'm Coming to (OUTCALL ONLY):

Hotel Name & Room Number (OUTCALL ONLY):

BY SUBMITTING THIS FORM, YOU AGREE THAT THIS INFORMATION IS CORRECT, AND YOU ARE NOT IMPERSONATING SOMEONE ELSE. *

I Agree

I KNOW I WILL BE REQUIRED TO FILL OUT 2257 & CONTENT RELEASE FORMS WHEN FILIMING. *

I Agree

Best way to reach me is through this form or by emailing me at [email protected] Real world information is REQUIRED, there are absolutely no exceptions. Please fill out this form or e-mail me a picture of your photo ID next to your face, along with the other information requested on this form. You can't get into a bar, brothel, strip club, ect without ID. you also can't legally film porn with out showing two forms of ID ~ why should anyone get access to companions with out showing ID? Thank You For Your Cooperation!

BOOKING FORM

BOOKING FORM

Safety Screening REQUIRED

About You

Contact Information

Booking Details

Safety Screening & Age Verification