The 10,000Yen Roppongi
Reservation form
Name (Required)
Email address (Required)
Cellphone number (Required)
Meeting place
Please select below
Hotel
Your home
Meeting outside
Address 1 (Required)
Address 2
Have you met our girls before?
Please select below
First time
2-4 times
Over 5 times
Name of girl
1st choice (Required)
2nd choice
3rd choice
If you don't mind anyone, just put N/A in the box of 1st choice.
Date (Required)
Please select a Month
January
February
March
April
May
June
July
August
September
October
November
December
/
Your convenient time (Required)
AM
PM
(e.g. 10AM)
Utility time (Required)
min.
Remarks (Optional)
If you have any requests, please let us know.
Process of Reservation
1.When we receive your reservation, we send back an email you.
2.On the day, we make a phone call for a confirmation before the time.
3.Then you can enjoy it!
If any error occurs, please call us directly. Thanks.
http://www.the10000yen.com/roppongi/frn/