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Name *

First Name	Last Name

Age *

Preferred Method of Contact *

E-Mail *

Phone Number *

Home City *

Desired Meeting City *

Desired Meeting Date *

Desired Meeting Time *

Desired Meeting Duration *

How will you handle the deposit? * Cashapp Venmo Zelle

Any special requests?

How did you find me? *

<3 Screening <3

Information conveyed will remain strictly confidential. It is securely encrypted and discarded from the system after 7 days.

How would you like me to verify you? * Discreet business phone call Discreet business email Email or text me your ID or passport LinkedIn (connect with my discreet account)

<3 Terms and Conditions <3 I understand a Deposit is required to schedule Bella Rose's time. I acknowledge Bella Rose's Deposit and Cancellation policies by submitting this form.
Deposits are non refundable unless I cancel. You agree that should you need to cancel according to the cancellation policy, a fee will be assessed and be required to be paid electronically. Should you decide to attempt to charge back this fee, this document will serve as evidence against any and all charge backs placed. Should you pay with an electronic means, whether payment be for compensation for my booked time or a cancellation fee that is required per my cancellation policy, this document acts as proof that you understand the policy and that you consented to pay for my services via electronic services. The same is also true should you pay for services via credit/debit/electronic means and then attempt a charge back.

<3 I am looking forward to getting acquainted. Our adventure awaits! <3

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