HotWildStrippers.com - Party Reservation Form

Please Enter Contact Information

First Name *

Last Name

Party Address *

Hotel Name (If Needed)

City *

State *

Zip Code *

Phone Number *

Phone Number 2 *

Email Address *

How Did You Find Us? *

Month *

Day *

Party Time (Start Time For The Entertainers) *

Party Occasion (Please Select) *

How Many Guest's (Please Select) *

Age Range of Guest's (Ex. 25-30 yrs. old) *

Type of Guest's (Please Select) *

I Need (Please Select) *

Type of Party (Please Select) *

Choose Entertainers (Seperate By Comma's) *

Second Choice's *

Costume Request

Payment Type *

Cash

Credit Card

Payment will be on arrival of the entertainers.

Thank You