Please fill out the form below as much as possible. If you do not have companion references, please complete the employment information section.  I assure you that the screening process is very discreet and all your personal information will be kept strictly confidential.  You can also book our time together by calling 305.742.8274 or via email at janine_miami@yahoo.com from Monday to Friday from 10.00 AM to 8.00PM.
 
Your Information
Full name
Contact Cell Number

Email address
Preferred Method of Contact
City of Residence
Companion Reference #1
Companion Website
Companion Contact Number
Date of last visit with her (something to refresh her memory)
Companion Reference #2
Companion Website
Companion Contact Number
Date of last visit with her (something to refresh her memory)
Companion Reference #3
Companion Website
Companion Contact Number
Date of last visit with her (something to refresh her memory)
Date Check ID
Preferred 411 ID
TER Handle
Occupation
Employer Name
Employer Main Number
Employer Website
Meeting City
Meeting date
Meeting time
Incall/Outcall

Please select a package of your preference
 1 hr.
2 hrs.
3 hrs.
5 hr. dinner date
12 hrs.
Overnight
All day
Weekend
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