Screening is a requirement to meet me.
Once I have seen you, your information will be updated to an email, phone number and first name, and stored in an encrypted database, only used to furnish references.
All other information will be destroyed.

I am NDA friendly.

Not a fan of forms? You may also send me a direct email (zoeybelle@protonmail.com) with all of the information required in the form below.

P411 member? You may send a request here.

If you have NSFW specifics you’d like to discuss before making a formal inquiry, I offer paid consultation calls.

About You

Name

First and last legal name.

First Name

Last Name

Email Address

Double check to make sure your email is correct.

Email Address Confirmation

Phone

If you are in the US, enter 1 for country code.

Country

(###)

###

####

Preferred method of communication?

My texts are always discreet, but I will never text without your permission. If texting is only OK during certain hours indicate so. If email, make sure to check your spam folders. My first email often finds it's way there.

Date of birth

YYYY

What city do you live in?

City and state of residence.

Occupation

About our date

What city would you like to see me in?

Desired date, time, and length of date. Please list an alternative date/time if possible.

If pre-screening or inquiring to compare schedules, just indicate so here.

What are you interested in exploring together?

Where did you find me?

Please name the specific website or social media.

Other details

Have you seen a provider before?

If you have provider references, please list them here.

Please include their website, ad, social media, or some other form of verification and how I can contact them.

Additional Verification

If you don't have references please attach links to at least two of the following: LinkedIn, your personal or company website, social media links, facebook profile, instagram, etc. I may ask for photo ID and further verification if needed.

Have you read over my rates, deposit requirements, and cancellation policies? Do you agree to them?

Are you prepared to provide a deposit via one of my accepted forms of payment in a timely fashion?

Bitcoin, gift cards, or cash. Other methods are available at my discretion.

Is there anything else you'd like me to know?

If you have any injuries, health concerns, or other information pertinent to our date please indicate here.

Would you like to be added to my mailing list?

Acquaintance & Contact