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* 1. Please provide your name and contact details, in case we need to contact you.

* 2. Which escort agency company did you pay money to?

* 3. How did you find out about the escort agency?

* 4. How much did you pay them?

* 5. When did you pay them?

* 6. How did you pay?

* 7. Have you got the details of the bank account you paid money into? If possible please provide the name of the bank, account number and sort code.

* 8. What promises were made to you to induce you to pay the fees?

* 9. What did you get for your money?

* 10. If you received nothing did you try and obtain a refund and were you successful?

* 11. Would you be willing to make a statement to us regarding what has happened to you?

* 12. If you have any other information and comments, please do so in the below section

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