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 without showing two forms of ID ~ why should anyone get access to companions without showing ID? Thank You For Your Cooperation!