SUBMISSION REQUEST

Name

First Name

Last Name

Phone

(###)

###

####

MUST FILL OUT BELOW

CONSENT

DO YOU CONSENT TO ME CONTACTING YOUR PROVIDED PHONE NUMBER AND EMAIL

AGE

ARE YOU OVER 21 YEARS OLD? YES/NO

KINKS & limitS

EXPERIENCE

HOW DID YOU GET STARTED. REFERENCES ARE A PLUS

HOW WILL YOU SERVE ME

THANK YOU FOR FILLING THIS OUT. i DO LOOK FORWARD TO READING ABOUT YOU.

-IF YOU DO NOT SEE A KINK LISTED ON MY WEBSITE, DON'T BE SCARED TO ASK! -NEWBIES ARE WELCOME AS LONG AS YOU ARE OVER THE AGE OF 21.

PRIVACY IS IMPORTANT. YOUR INFO WILL NEVER BE SHARED UNLESS THERE IS A LEGAL MATTER THAT REQUIRES ME TO.

I ALWAYS MASK ONLINE BUT I DO NOT IN PERSON UNLESS REQUESTED.

I RARELY TAKE OUTFIT REQUESTS. IF YOU REQUEST WITHOUT FUNDING FOR IT YOUR REQUEST OR SESSION MAY BE DENIED.

DID YOU MAKE A TRIBUTE

YES, I WANT TO BE NOTICED

NO, I CAN BE IGNORED

TRIBUTE HERE

This website, www.MISSJADESMOKE.COM

& MisS JADE SMOKE is not promoting escort services of any kind and does not condone any sexual acts or any type of illegal service of any kind. MISS JADE SMOKE DOES NOT DO OR ALLOW DRUGS IN SESSION.

Any discussion with misS JADE IN REGARD TO services are solely between the mistress AND YOU.

Services performed between the mistress and the client are a mutual agreement kept between the mistress and client.