EmailMe Form - Slave Application Form

Basic Information
Name *
First Last
User Name(s) Commonly Used *
Website(s) User Name(s) Used On *
Email *
Must be valid!
Skype? *
If yes, provde User Name
KiK Messenger? *
If yes, provide User Name
Birthday
MM / DD / YYYY
Sex *
Female
Male
Transgender
Location (City, Country)
Marital Status
Children
No
Yes
If yes, specify how many, how old and living situation.
Living Situation
Sexual Orientation
Health & Fitness
Weight (kg)
Height (cm)
Cigarettes (per day)
Alcohol (avg. per week)
Sports
No
Yes (what, how often/week)
Current health condition?

Poor
1

2

3

4

5

Excellent
Any problems with/
medical history of?
Brain wave abnormalities
Circulation
Diabetes
Dizzy Spells
Eye Sight
Fainting
Hearing
Heart
High blood pressure
Hypergycemia
Hyperventilation Attacks
Kidneys
Leg Cramps
Liver
Lungs
Mental Illness
Neck/Back/Bones/Joints
Nervous System
Seizure disorders
Seizures
(Check all that apply)
If yes, explain:
Have you had a heart attack?
No
Yes (if yes, when?)
Are you currently taking any medications?
No
Yes (If yes, which?)
Allergies (Food, Drug, Metals, Animals,..)?
No
Yes (if yes, list them)
Occupation and Expenses
Employment Status?
Occupation Title/Description
Working Days/Hours
Monthly Salary
$ Dollars . Cents
Average monthly income if not salary.
How much is your average disposable income a month?
$ Dollars . Cents
After all other bills and expenses are paid.
Rent or Own?
Rent
Own
Kinks & Fetishes
What fetishes are you interested in?
Anal Sex/Toys
Blackmail
Chastity
Cuckolding
Diet Control
Exhibitionism
Financial Domination
Foot Fetish
Forced Bisexuality
Forced Feminization
Micromanaged (curfew, etc.)
Nipple Clamps/Play
Orgasm Control
Orgasm Denial
Other
Private Humiliation
Public Humiliation
Sensory Deprivation
Slut Training
Small Penis Humiliation
Smoking
Spanking
Speech Restrictons
TeamViewer
Be aware that although I take note of the things you enjoy, unless it is your hard limit, anything on this list may be used for assignment or punishment.
Hard Limits
DO NOT LEAVE THIS BLANK *
Anything that you cannot/refuse to do for any reason. (Example: scat, anal, animals, etc.)
Is showing your face a hard limit? *
No, but I do not want my face shown publicly.
No, you may show my face publicly.
Yes, but I can wear a mask or face covering for proofs.
What tasks can you do? Check all that apply
Email
Leaving/Receiving Voicemail
Online Journal Logging
Picture Proof (phone/cam)
Texting Message/KiK
Video Proof (phone/cam)
Webcam
What toys, equipment, or clothing do you currently own?
Anal Beads
Anal Plug
Anal Spreader
Animal Costumes
Ball Gag
Bit Gag
Chastity Device
Cock Ring(s)
Dog Cage
Dog Collar/Leash
Dress(es)
Fantasy Dildo
Flogger
Fuck Machine
Gates of Hell
General Makeup
Heels
Inflatable Anal Plug
Muzzle
Nipple Claps
Paddle
Panties
Pocket Pussy
Prostate Massager
Realistic Dildo
Regular Dildo
Spreader Bars
Squirting Dildo
Standing Cage
Stockings
Weighted Nipple Clamps
Wig(s)
Do you want to be pimped out?
Yes
No
Do you consent that you are acting upon your own free will and are not being coerced into applying for Consensual Financial Domination? *
Yes
No
What type of Financial Domination are you seeking?
Selective
Complete
Consensual Blackmail
I want to live on a Monthly Budget
I want to be Financially Ruined
I want to be forced to save money
Other
How often do you see yourself paying dues or giving gifts to Mistress?
Low Income: As Able To
Daily
Weekly
Monthly
Yearly
As Commanded
Special Occasions Only
(Select all that apply)
About You

Be as specific as possible.

Describe yourself. Do you have any special skills or talents? If so, what are they?
What past BDSM experience do you have? Have you ever served a Mistress before?
Describe your ideal slave situation in detail. And what would your average day be like?

Upload one photo of yourself, full body.

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Basic Information

Health & Fitness

Occupation and Expenses

Kinks & Fetishes

About You