Adult Only Escort Service Request
Fill the form and then press "Confirm (確認)" button.
Name
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Email Address
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Gender
Couple
Single Male
Single Female
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Nationality
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Residence Address (City/Country)
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URL of your face photo
Visiting Date(s) to near Tokyo (Day/Month/Year)
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Service Request Type
Trip - Secret Beach
Trip - Hot Spring (mixed gender)
Swingers Club
Gangbang Party
Other (please specify in your mail body)
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Your profile including sexual behavior
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Misc/Others
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