Disclaimer Notice: By submitting this form you agree not to hold Me liable for any damages caused by the information provided below. By submitting this form you are consenting to consensual involvement in Financial Domination/Money slavery and/or Blackmail. You MUST also sign and return the release to hold harmless form.
Full Name:
Email Address:
Phone Number:
Work Phone Number:
Residential Address:
City:
State/Province:
Country:
Postal/Zip Code:
Physical Description:
Height:
Weight:
Age:
Any Health Concerns I should be aware of:
Marital Status:
Girlfriends
Boyfriends name:
Email Address of this person:
Number of Children:
FINANCIAL and EMPLOYMENT INFORMATION
Where do you work?:
Contact number :
Work address:
What
Annual
Money in Bank Accounts:
Checking:
Savings:
Do you own your home? What is it worth?
What type of vehicle do you drive?
Value:
Credit Card and Available Credit on each card
Visa:
Credit Available:
Amex:
Credit Available:
Master Card:
Credit Available:
Other: line of credit?
Credit Available:
Monthly Expenses
List ALL your monthly expenses: Put what they are and how much you pay.:
List all monthly expenses above that you can and will cut back on to send Me more money:
Tell Me a secret so embarrassing you wouldn't want anyone to know. Do not wimp out on this.. I want the truth and I want it to be GOOD! :
Now name the one person you would never want to know this:
Phone number of this Person:
Email Address of this person:
Experience, Desires and Interests
Under Experience answer with y=yes n=no to whether or not you have experienced that activity.
Sexual Preference: _X Heterosexual _Bi-Sexual _Lesbian/Gay _Anything
Goes
Have you ever performed fellatio (oral sex on a man, “blow job”)?
If you have not, how do you feel about the possibility of being
Required to perform fellatio? Unsure
If you have, did you or didn't you enjoy it? Why or why not?
If you have, did the man come in your mouth?
If yes, did you swallow? Why or why not?
Have you ever had anal sex?
If you have had anal sex, did you enjoy it? Why or why not?
If you did not enjoy it, what do you think could be done to make it
Enjoyable for you?
If you enjoy anal sex, how often have you engaged in it?
Have you used anal adult sex toys, I.e., butt plugs, anal probes,
Vibrators, dildo's, etc.?
If so, were they used on you or did you use them on a partner?
If they were used on you, which ones have been used on you?
Did you enjoy any of them?
If so, which ones you did you enjoy?
Which ones didn't you enjoy?
Are there any anal toy you have seen that you would like to try?
What size(s)?
If you used them on a partner, which ones did you use?
Did you enjoy using them on a partner? Why or why not?
Was the partner male or female?
If you have not had anal sex, have you ever considered trying it?
How would you feel, or think you would feel about being asked to engage
in anal sex?
Have you ever performed oral stimulation to a anus?
Did you enjoy it? Why or why not?
How do you feel, or think you would feel about performing it? I
Have you ever worn lingerie? (Aside from conventional bras and
panties.)
If so, what have you worn?
How did you feel about wearing lingerie?
Do you currently own any lingerie? If so, what?
Do you currently own a garter belt and stockings? shoes?
How do you feel, or think you would feel about going lingerie shopping?
Have you ever, or do you now, shave, wax, depilatory, or otherwise
removed your pubic hair?
How did you remove it?
Would you be willing to partially or totally remove it as a sign of
your submission?
Would you be willing to wear an outward sign of your submission, i.e.,
a special ankle bracelet, wrist bracelet, necklace, or earring?
How would you feel, or think you would feel about having explicit
photographs or video made of you?
HOT WAXING (candles)
HUMILIATION (verbal)
ARM RESTRAINTS
HUMILATION (public)
ICE CUBES
KNEELING
BLINDFOLDS
LEATHER
BODY WORSHIP
LEG RESTRAINTS
BONDAGE
BOOT WORSHIP
MASTURBATION
BREAST WORSHIP
NIPPLE CLAMPS
C & B TORTURE
NIPPLE WEIGHTS
CLOTHESPINS
NIPPLE TORTURE
COCK WHIPPING
OVER THE KNEE SPANKINGS
COLLARS/LEASHES
ORGASM CONTROL
CROSSDRESSING
ORGASM DENIAL
CUFFS (metal)
PADDLE
EATING your own CUM
PANTY WORSHIP
PIERCING
ENEMAS
PUNISHMENT
EXAMINATIONS
PUSSY WORSHIP
EXHIBITIONISM
RIDING CROPS
FORCED NUDITY
RIMMING
FOOT MASSAGES (GIVING)
ROLE PLAY (kidnapping ect)
FOOT WORSHIP
SERVING AS A HOUSEBOY
GAGS
SERVING AS FURNITURE
GOLDEN SHOWERS
SHAVING (GENITALS & FULL BODY)
SPANKINGS
HIGH HEEL SHOE (WORSHIP)
SPREADER BARS
STRAP ON DILDO (oral)
HOT OILS (GENITALS)
WHIPPING/ FLOGGING
What toys do you own?
