Request

Request an invitation to Haus of Amira

Amira is available by invitation only. Please submit your application below.

    Your Details

    * Full Name:

    * Email:

    * Telephone Number:

    Appointment Details

    * Date of Booking:

    * Time of Booking:

    • :

    * Type:

    * Incall/Outcall

    * Please provide your location name and address:

    * Please provide your location name and address including country & city:

    Screening Options
    (choose your preferred method of screening)

    Employment Verification

    * Position:

    * Company name:

    * Company main phone number:

    * Your direct line:

    * LinkedIn page:
    with 250+ connections and profile picture.

    ID

    * Please provide a copy your photo ID (max file size 5mb):

    P411

    * Please provide your P411 details for verification:

    Additional Information

    * Where did you hear about me?

    * If other, please state below:

    * Please enter the directory name below:

    Would you like to share your picture with me? If yes, please upload. (max file size 5mb)

    Is there anything I should know before I respond?

    How would you like to feel leaving Haus of Amira?

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