Companions Of Atlanta

Pre-Screening Form

Thank you for using Companions Of Atlanta.
Please fill out our pre-screening form completely.
If we feel your information is incomplete or inaccurate we will not be able to screen you based on this form and you will have to call us for a full screening. For us to screen you properly you must provide us with as much information as possible.
Our screening process is discreet and all information provided is disposed of once you have been verified.

Personal Information

* First and Last name (As shown on your Drivers License):

* Age and Birthdate:

* Email Address:

* Mobile Number:

Business Number (This must go through a company directory or receptionist):

* Job Title:

* Company Name:

Company website (If applicable):

References

Please provide us with as many provider or service references as possible, this will help us exceed with your screening.

Provider or Service Name:

Provider or Service Number:

Provider or Service Website:

Provider or Service Name (2):

Provider or Service Number (2):

Provider or Service Website (2):

Please include any additional references or information here:

Appointment Information

* Desired Model

* Appointment Date:

* Appointment Time:

* Have you used our service before?

* How would you prefer for us to contact you:

Comments:

By clicking the Submit button and typing your name in below you agree to the following:

You understand that by filling out this form that you are not guaranteed your requested appointment time and that you will have to call in order to book your appointment.

You understand and agree that all models listed with Atlanta Companions II are private independent entertainers and are simply companions that offer services for their time and nothing more.

The information you have provided on this form is true and accurate and not misleading in any way.

You understand that Atlanta Companions II will always be discreet and confidential and only uses the information provided for our personal screening and disposes of all said information once reviewed and confirmed.

You agree that you are a legal adult 18 years of age or older.

* Form Signature (Your full name):

* Todays Date:

* Indicates Response Required