Registration form - establishment


                                 Identification number (leave blank):___________



Establishment name: ____________________________

Type: __________________________________________ (Night Club, Escort service...)

Street: ________________________________________ 

City: __________________________________________

Contry:  _______________________________________

Phone: _________________________________________

Fax: ___________________________________________

E-mail: ________________________________________        

www address: ___________________________________

Opening hours:  Mon-Fri:  ______ hrs. - ______ hrs.

                Sat-Sun:  ______ hrs. - ______ hrs.

Entrance fee: ____________ (currency)

Facilities: ____________________________________ (pool, bar, sauna...)

Program: _______________________________________ (striptease, lesbi-show...)


*) Accepted Credit Cards: 
Visa - Visa Elektron - Eurocard/Mastercard - Cirrus/Maestro
American Express - Diners Club International - JCB

Descriptive text (this field is REQUIRED for registration):
























By signing  submitting this form, I hereby agree with publishing all the aforementioned data as well as the accompanying images at the Escort online server.

                                                                ________________
                                                                    Signature

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*) Scratch the not applicable options