RESERVATIONS | trinablack

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First and Last Name*

Email*

Registered Phone Number*

Are You a Las Vegas Local*

Yes

No

Date picker*

Your Place or Mine?*

Only Available for Regular clients

Available locations*

Preferred Appointment Length*

Flexible on date and time? *

Flexible

Not Flexible

Preffered Mode/Time for communication*

Text

Email

Morning 8am - 12 noon

Afternoon 12pm - 4 pm

Evening 4pm - 9 pm

Tell me little about you and what endeared you to me. Interesting date idea?*

Where Did You Find Me?

Using References? Kindly Include TWO References & Their Website/Ad & Contact Information*

Employment Verification - This Requires either Your LinkedIn or Company Work Email*

Agreement

I agree to the term and conditions

I understand the deposit and cancellation policy

Signature*

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