Interest Request Form

Interest request Form

CBT PLAY

Getting the most

Interest Form

Contact Information
First Name*
Last Name*
Phone Number*
- Area Code Phone Number
E-mail*
Birth Date*
Month Day Year
Do You Prefer Confirmation By:*
If By Phone -Best Time To Reach You?*

8:00 AM - 11:00 AM 11:00 AM - 2:00 PM 2:00 PM - 5:00 PM After 5:00 PM I will call you!
What is your first choice for an appointment?*
- Month - Day at Year / Hour Minutes
What is your second choice for an appointment?*
- Month - Day at Year / Hour Minutes

Interest Form

Session & Tributes
Which Session Would you like to book?
How many hours would you like to book?

1 Hour $200.00 2 hours $300.00 3 hours $400.00 More
Would you like to add services to your session?
Please send a photo of yourself.
Making sure you're human!*
Tribute
USD Tribute
Should be Empty:

NOTE: I do NOT offer any service that falls under the definition of prostitution as has been defined by the laws and ordinances of this city and state. So don't even bother asking. play is in a safe discreet location. I do not follow a script and I appreciate not being asked to do anything that is illegal.

Last Updated Monday, February 14, 2011 11:48 AM

Interest request Form

Getting the most

Interest Form

Interest Form

Interest Form