A
First Name: Age:   Hair Colour:
Sexual Preference: Weight:   Eyes:
Language Spoken: Height:   Measurements:
Other Language: Tattoos:   Drinking:
Availability:       Smoking:
Prices:         Drug use:
1 Hour Some words about yourself:
4 Hour    
1/2 Day:    
Dinner & Later: Your preferred client base:
Full Day:    
Weekend: Topics of Interest:
Contact No:    
Do you have pictures? Services offered:
If no do you want us to assist?    
       
  Anything else:
       
If you would like to take advantage of this offer simply complete this form and press SUBMIT FORM at the bottom and we will contact you. (Dont forget your contact phone number)

Atlernatively you can complete and print this form and post with photographs to:
  If you wish to discuss further please reply to SMS or phone:

Graham 0421 581 586
Bob 0412 201 651
12-vision
PO Box 438
Ormeau
Qld 4208
 
Many thanks for your time. This is a 'once only' offer and we will not contact you again so why not give it a go now.

Note: your email address will NOT be used for any other purpose.