First impressions are long lasting so make yours memorable! Full Legal Name * First Name Last Name Age * Nationality * Phone * (###) ### #### Email * Preferred method of contact * Phone Email Whatsapp Desired Date * MM DD YYYY Desired Time * Desired Location * Please select one Incall (Fees apply) Outcall FMTY Virtual Desired Length Of Date * 1 Hour 2 Hour 3 Hour Extension 4 hour Dinner Date 6 Hour Dinner Date 12 Hours Overnight 24 Hours 48 Hours Longer Duration - 1 Week Where would you like to see me? * London, Europe, SG, USA LinkedIn or business website http:// Provider Reference #1 * Include the name, email, and website address of someone you've met in the past 6-12 months Provider Reference #2 Include the name, email, and website address of someone you've met in the past 6-12 months Message from you * I would love to know more about you and what you hope to gain from this experience xx When was your last health screening? * I take my health and your health very seriously, I regularly get tested and request my dates do too. You understand you are required to complete screening in the form of a reference or clear uncensored photo ID + selfie * You understand that I require a discreet non-refundable deposit for all encounters * You understand my rates are non-negotiable * You understand that all other requirements listed this website are strictly upheld & a failure to comply will result in the termination of our correspondence or appointment without a refund. * Thank you, I’ll get back to you as soon as possible! All data is protected and secure Copyright © Amelia banks 2024