This information is sent to our email and not stored on the web

This information is for Our protection and yours, once verified we do not sell, keep or distribute this information, we do this because of law enforcement, even if you say your not in law enforcement we still need this information to verify who you are. Please understand us girls we need to be able to verify you are legit

Fill the form below and we will get back to you as soon as possible.

Fields marked by * are ALL required.

Please mention two personal references from other upscale companions that you are acquainted with. Be sure to include accurate contact info. If you enter these 2 References you can bypass entering your personal info.

Members of my site are offered a discount.

Please ask my assistant when she contacts you for the details of this discount.

You Must Put Something In ALL Fields Marked with *

otherwise form will not go through to our email

Please Note this information is not stored on the web, distributed or sold.

Your Full Name  *

Home Address  *

Home City  *

State/Province  *

Zip Code 

Enter your email address (without verification we can not set up your appointment):  *

Date and Time of Appointment Requested  *

Desired Length Of Service  *

City of Appointment:  *

Name of Business or Employment:  *

Work Number (without verification we can not set up your appointment):  *

Work Extension: 

Title or Position in Company: 

Cell Phone Number:  *

Home Number (Not Cell Phone) (without verification we can not set up your appointment):  *

Age:  *

Height:  *

Weight:  *

Hair Color:  *

distinguishable features 

References of Other Porn Stars/Famous Escorts you have had appointments with including the persons phone number, city of appointment and escorts name. We need this so we can verify you (without verification we can not set up your appointment):  *

Any comments, questions or special requests? 

Are you a member of my website?  *


How or where did you find Kayla?  *

Do You work in Law Enforcement , or any job pertaining to Law Enforcement? Please Explain:  *

Copyright (C) 2008 - KaylaKupcakes.com - Site Designed By: http://www.nexxxtdesign.com