<div class="half-left">	
<h4>Personal Details</h4>
<label>Your Name:</label>[text* realname class:textbox1 placeholder "Real Name"]
<label>Working Name:</label>[text* workingname class:textbox1 placeholder "Working Name"]
<label>Your Phone Number:</label>[number* phonenumber class:textbox1 placeholder  "Your Phone Number"]
<label>Location:</label>[text* location class:textbox1 placeholder "location"]
<label>Age:</label> [text* age class:textbox1 placeholder "Age"]        
<label>Email:</label>[email* email class:textbox1 placeholder "Email"]
</div>		
	
<div class="half-right">
<h4>Appearance</h4>	
<label>Hair Colour:</label>[text* Hair_Colour class:textbox1 placeholder "Hair Colour"]
 
<label>Eye Colour:</label>[text* Eye_Colour class:textbox1 placeholder "Eye Colour"]
 	      
<label>Height:</label>[text* Height class:textbox1 placeholder "Height"]
 

<label>Statistics:</label>[text* Statistics class:textbox1 placeholder "Statistics"]
 	
<label>Are your breasts natural or enhanced:</label>

<span class="radio-button-area">[radio enhanced default:1 "Natural" "Enhanced"]</span>

</div>	

	
<div class="clear"></div>	
	
	
	
	
	
<h4>Photos</h4>
<p>Please upload as many professional and natural pictures as you have of good quality. The natural pictures are for information and assessment of your potential only. </p>
	
	
<p>Please Note:</p>
<ul style="color:#fff;">
<li>At least 3 photos Required.</li>
<li>Try to upload images with a maximum of 5MB</li>
<li>Please use only jpeg/ png/gif file extensions</li>
</ul>
<div class="half-left">
<label>Choose File</label>[file* Photo_1 limit:10mb filetypes:jpg|png|jpg|jpeg class:textbox1]
<label>Choose File</label>[file Photo_3 limit:10mb filetypes:jpg|png|jpg|jpeg class:textbox1]
</div>	
	
	
	
	
	
<div class="half-right">

<label>Choose File</label>[file Photo_2 limit:10mb filetypes:jpg|png|jpg|jpeg class:textbox1]
<label>Choose File</label>[file Photo_4 limit:10mb filetypes:jpg|png|jpg|jpeg class:textbox1]
</div>		
	
	
	
	
	
<label>Comments</label>	[textarea Comments class:textbox1 6*6]
	
[captchac captcha-778 size:s fg:#ffffff bg:#000000]
[captchar captcha-778 class:textbox1 4/4]


<div class="clear"></div>	
[submit class:submit-button "Submit"]
1
Manchesterescorts.co.uk - Employment Form
info@manchesterescorts.co.uk
info@manchesterescorts.co.uk
Name: [realname]
Working Name: [workingname]
Phone Number: [phonenumber]
Location: [location]
Age: [age]
Email: [email]
Hair Colour: [Hair_Colour]
Eye Colour: [Eye_Colour]
Height: [Height]
Statistics: [Statistics]
Are your breasts natural or enhanced: [enhanced]


Comments: 
[Comments]

-- 
This e-mail was sent from a Employment Form on www.manchesterescorts.co.uk
Reply-To: [email]
[Photo_1]
[Photo_3]



bossagency "[your-subject]"
bossagency <info@bossagency.co.uk>
[your-email]
Message Body:
[your-message]

-- 
This e-mail was sent from a contact form on bossagency (http://localhost/bossagency)
Reply-To: info@bossagency.co.uk



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