Screening form for Jessica Perry

I have included three methods of verification: References, Preferred411, and "Newbie Screening." Please choose at least one.
Name Name * First Last
Age *
Email *
Phone* Phone* * - ### - ### ####
The Date: *

The Date: 1 hour (outcall only) 90 minutes 2 hours Meet Me for Cocktails (3 hours)* Dinner (or Lunch) & Dessert (4 hours - my favorite!)* A Night on the Town! (6 hours)* Sleepover & Breakfast in Bed 24-hour Escape Weekend Getaway
*Dates 3 hours or more require refreshment, and time outside the room. If you prefer to remain behind closed doors for the entire date, please add 25% to the fee posted in my 'Donations' section.

*Dates 3 hours or more require refreshment, and time outside the room. If you prefer to remain behind closed doors for the entire date, please add 25% to the fee posted in my 'Donations' section.
My place (a lovely hotel) or yours? *

My place (a lovely hotel) or yours? My Place (deposit required) Your Place Other Other
Screening Option 1: References
Please provide *at least* two references from established, reputable companions who can vouch for you as a client.
1. Name:
Her website:
Her email address:
2. Name:
Her website:
Her email address:
3. Name:
Her website:
Her email address:
Screening Option 2: Preferred411
P411 ID
Screening Option 3: Newbie Screening
If you do not have references, please read the following:

I will need your full name, plus at least one way for me to confirm your identity - usually, a published business email address and/or website.

I will email you a bland, generic, tech-related newsletter, mailed from an unpublished email address not related or traceable to ‘Jessica’. Please reply with a blank email, 'Please remove me from your mailing list,' or anything else you think is appropriate.

Once I verify that you are safe for me to meet, I will delete the information.

I will never ask to speak with anybody other than yourself, nor will I ever contact you without your permission.
Company Name:
Company Website:
Company e-mail or main phone number through which I can contact you, by asking for you by name; and a cover story if needed:
Please use the space below to include some information about yourself...

I always like to know something about who I'll be meeting :) You don't have to write a lot - just enough to break the ice and give me a sense of who you are. Where you're from, what you like to do, etc. Also, if there is anything you would like me to know about you before we meet.

Screening form for Jessica Perry

Screening Option 1: References

Screening Option 2: Preferred411

Screening Option 3: Newbie Screening

Please use the space below to include some information about yourself...