Name: First_ MI_Last_

Mr./Ms (circle one)

Street Address-

City_State/Province_Zip/Postal Code_

Telephone Day_Evening_

Please describe, in as much detail as possible, your fantasy. If you need extra space, you may use the back of this form._

In order to fulfill your fantasy, it may be necessary for us to do a background check on you. Is this acceptable? Yes/No

(Circling "no" will not preclude us from fulfilling your fantasy; however, it may not allow us to fulfill your fantasy to your full satisfaction.)

Note: There are some fantasies we will refuse. Examples are ones of an overtly sexual nature, ones that involve illegal activity, or those involving cruelty to people and/or animals.

Please remit a down payment of $1,000 with this application. If we accept your fantasy, the rest of the payment will be due at least one month before your fantasy commences.

After receiving your application, we will send you a postcard saying we've gotten it. The revuing process takes approximately one month. DO NOT TRY TO CONTACT US DURING THIS PERIOD.

If we decide not to fulfill your fantasy, we will return your deposit minus a $100 application fee.

BRIBES ARE ABSOLUTELY FORBIDDEN, AND WILL RESULT IN AN AUTOMATIC REFUSAL!

I enclose a:

_Check

_Money Order

_Credit Card

Type of card_

Card#_Expt. Date_

(No cash, please.)

I affirm that the information given is completely true and accurate.

Signed_Date_