Payment Center

Pay securely by VISA, MasterCard or American Express using this form. Once your credit card transaction has been processed, you will receive confirmation via e-mail with an e-signature form to secure your payment, it also will consist of my signature for a refund if necessary.




Location of Appointment:
If traveling (what city or state)
Best Time To Confirm Appointment:
Best way to reach you:
Which Engagement would you Like: ("Refer to service rate page for this information")example;Limited, full, Extended Engagements.
Service Rate of the engagement. $300 0.5 hours duration Limited Engagements
$450 1 hours duration Limited Engagements
$600 1.5 hours duration Limited Engagements
$750 2 hours duration Limited Engagements
$850 2.5 hour duration Limited Engagements
$1100 3hour duration Limited Engagements
$500 local-$700 out of town 1 hour Engagements
$1,000-$1,300 out of town 2 hours Engagements
$1,500-$ 1,700 out of town 3 hours Engagements
$1,800 4 hour evening date Extended Engagements
$2,100 6 hours evening date Extended Engagements
$2,500 8 hours evening Extended Engagements
$2,800 12 hours overnight Extended Engagements
$4,000 24 hours overnight Extended Engagements
Would you like to leave a tip? if so,how much? You can alway tip later.
Date and Time of appointment:
First Name:
Last Name:
Zip Code:
Email Address:
Phone Number:
Method of Payment:

Mail Payment to: Kim Eternity

642 Palomar Suite 406 #237

Chula Vista Ca 91911

Credit Card Number:
Expiration Date:
Engagements check all that apply Limited Engagements
Lingerie & Bikini Modeling Hostess & Events Coordinator
Nude Dancing
oil hand rubs
One Girl show with extras
Full Service Engagements
GFE be my sugar daddy
Porn Star experience shows w/dvd
Bachelor Party's w/ dvd
Extended Engagements
Just some good ole Entertainment
Engagement Amount:
CVV2 Number (located on the back of your card):
Credit Card Authorization This form is a legally binding agreement under the laws of the state of California. Do not check this box unless both dollar amounts on this form match and you agree with the terms stated herein. This contract must be completed by checking this box.
Total Amount to be charged
I agree with the return policy I have read the return policy

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