You Can Pay Using Google Wallet To My Email Addres:

You Can Pay Using PopMoney To My Email Addres:

(For Overseas Transactions)
You Can Pay Using To My Email Address: or #8186598708

* Please note that special requests require travel reimbursement.*

I am a professional and understand the need for discretion and confidentiality. Your information is viewed by me only and required for verification purposes only.


Full Name:*
Email Address:*
Date and Time of Appointment:*
City of Appointment:*
Name of Business or Employment:*
Work Number and Extension:*
Title or Position in Company:*
Cell number: *
Home number:
Hair Color:*
Other distinguishable features:
3-5 References-Other Porn Stars/Famous Escorts you have had appointments with:*
Any comments, questions or special requests?

An asterisk denotes a mandatory field. Please fill all required fields before clicking submit.

Note: If you are not taken to a Thank You page your reservations were not made.

Note: All deposits from services and products sold are made are non refundable.

Terms and Service:
*Brief description of my business to inform you my client that any services  I provide are exclusively related to modeling and / or companionship for a fee. Anything outside of the services I have detailed is a matter of personal choice and / or preference between two or more consenting adults of legal age and not part of any or in any way the compensation I am given for my time as a companion and / or model.

Copyright - Harley Raine - All Rights Reserved