You Can Pay Using Google Wallet To My Email Addres: xxxstarharleyraine@gmail.com

You Can Pay Using PopMoney To My Email Addres: xxxstarharleyraine@gmail.com

(For Overseas Transactions)
You Can Pay Using Riamoneytransfer.com To My Email Address:
xxxstarharleyraine@gmail.com 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:*
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:
Age:*
Height:*
Weight:*
Hair Color:*
Other distinguishable features:
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.

 

 


harley raine bio