Please allow our all female staff, here at Lourdes,
to help you arrange the introduction of a lifetime!

 

Please fill out our registration form below. We respect privacy and will not sell or distribute your information to any third party.

Lourdes Enterprise Registration Form


ALL INFORMATION MUST BE COMPLETE
Please be honest, we will need to discreetly verify you for her safety. You will be required to show ID.

* Indicates a required field.

Contact Information
* Country:
* First Name:
* Last Name:
* E-mail Address:   ?
Is it ok to email? Yes    No
* Contact Number:   ?
Is it Ok to text during business hours? Yes    No
 For verification purposes and confidentiality, we keep our clients discreet.
   
Personal Information
  Date of Birth:   ?
  Height:   ?
  Weight:   ?
  References:
Any girls you have seen. Please provide name of girl, email address and/or phone number as well as any information about the reference you wish to share.
 For verification purposes and confidentiality, we keep our clients discreet.
 
Occupation Information
* Name of Business:
* Business Phone: ?
* Position in Company:
* Business City:
  Business Website:   ?
 For verification purposes and confidentiality, we keep our clients discreet.
 
Additional Info
Are you a TER member or member of any other board? Yes    No
If yes, handle name:
Are you roomservice verified? Yes    No
If yes, City & State on ID:
How did you hear about us?
 For verification purposes and confidentiality, we keep our clients discreet.
 
Payment Information
How do you want to pay?
Credit Card Money Order Completed Appointment
(MC, Visa)