Please Fill out this request form as completely as possible.  An Dial-a-dancer Representative will contact you to verify your appointment and advise you on fees. Please use the comments form for any special requests.
Where will your model meet you?

Which Model would you like?

First Choice
(Female models)  

Second Choice
(Female models)  

First Choice
(Male models)  

Second Choice
(Male models)  

Date of Appointment?
Check your calendar carefully.

Exact Time
This is the exact time your model  
should show up at your door.

How long will your date be?
Extended time can be made available.

Method of Payment
How will you pay for our services?.

Hotel Name or Street Address
This is required to ensure proper delivery.
Hotel Name






Phone number at which you can be reached at this location.
This is the most important of all. This number either needs to be the hotel or the residence. Your model will call you before the appointment - the appointment will not take place if you cannot be reached. If you do not know the room yet, you can tell her on the phone when your model calls.

Phone Room or ext.

First and Last Name

For security reasons, your model will ask you for a valid identification, such as a passport or a driver's license. If in a hotel, you must be registered in your name. We keep this information discreet and confidential.

First Last

Alternate Phone
A mobile phone number or alternate phone number that might
help us contact you before the appointment.

Email Address
We will confirm your appointment via email.
E-mail Address (required)

Special Requests or Comments
Should we not call at certain times? E-mail only? Whatever your special /discretion requests are - they are respected.

How did you hear of us?
Help us out...we'll consider it a personal favor. Tell us how you found this web site. Which search engine? What keywords? A link from another site? A magazine? Please let us know how you found us so we know what we are doing right.

I understand everything is discreet. If I must cancel this appointment I will give 
an advance notice.