*Required fields
*First Name:
*Last Name:
*Street address:
Street address 2:
*State or Province:
*Zip or postal code:
*Phone number:
Reference numbers of ladies you wish to phone:
(seperate by commas)

When choosing times to call the ladies, take into consideration the time in the lady's city, so as not to wake her up in the middle of the night. Here are some approximate times right now:

I am available to make the calls at the dates and times below(the chosen times are in my country):


*I will pay by:
visa and visa electronmastercardamerican expressdiscover card

*Open my account with the following amount:
If you are paying by credit card, enter the card details here:
*Card number:
*Exp date:
*3 or 4 digit CVV code
Some credit cards have a 4 digit CVV code on the front of the card

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