First impressions are long lasting so make yours memorable Email - Helloameliabanks@proton.me Whatsapp - +61451674841 Full Legal Name * First Name Last Name Age * Nationality * Phone * (###) ### #### Email * Preferred method of contact Phone Email Desired Date * MM DD YYYY Desired Time * Hour Minute Second AM PM Incall / Outcall / FMTY ? Please select one Incall Outcall FMTY 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. Checkbox 1. You understand that I require a discreet non-refundable deposit for all encounters 2. You understand my rates are non-negotiable Thank you!