Jordan Kingsley Reservation Form
Fill the form below and we will get back to you as soon as possible. All fields marked with * are required.
1.	Full Name: *
2.	E-mail Address: *
3.	Address: *
4.	Date & Time of Appointment: *
5.	City of Appointment: *
6.	Name of Business or Employment: *
7.	Work Number and Extension: *
8.	Title or Position in Company: *
9.	Cell Number: *
10.	Home Number: *
11.	Age: *
12.	Height: *
13.	Weight: *
14.	Hair Color: *
15.	Other distinguishable features:
16.	Verification Services That You're A Member Of/Member IDs: *
17.	References:Other Porn Stars/Famous Escorts You've Had Appointments With(if you booked thru agency put agency info): *
18.	Comments, Questions, Special Requests?