EmailMe Form - Consensual Blackmail Application

Consensual Blackmail Application
So, you're into blackmail, huh? Want to be forced into giving me all your money so I don't show to the world what a pervert you really are? Yes? Well, hurry up and fill out this form, so I can start screwing you over!
I expect all forms to be filled out, and to receive the required pictures and a $50 Amazon Egiftcard in my email (PrincessMelodyBBW@yahoo.com) immediately after you fill out this form, or your application will be ignored.

About You

Name *

Prefix

First *

Last *

Suffix

Current Age *

Date of Birth *

YYYY

Home Phone Number *

###

####

Cell Phone Number *

###

####

Address *

Street Address *

Address Line 2

City *

State / Province / Region *

Postal / Zip Code *

Country *

Email

Marital Status *

Single

Married

Divorced

Significant Other's Name *

Prefix

First *

Last *

Suffix

Significant Other's Phone Number *

###

####

Significant Other's Email *

About Your Job

Company Name *

Company Address *

Street Address *

Address Line 2

City *

State / Province / Region *

Postal / Zip Code *

Country *

Job Title *

Monthly Income *

Monthly Disposable Income *

Maximum Weekly Tribute For Me To Keep Your Secret *

About Your Fetishes

* Here you will tell me about all of your fetishes...which one is your top secret fetish and any other information that can be used against you that you wish for me to have: *

About Your Friends

* Here you will give me the Name, Number, and Email of at least 3 of your closest friends: *

Initial Requirements

1. A picture of you holding up a sign that says “Princess Melody’s Piggy”

2. A form of identification proving your age…If using your Driver’s License the number may be blurred out.

3. An Amazon E-Giftcard of $50 or more to prove you are serious.

All should be sent separately from this form to princessmelodybbw@yahoo.com
Your application will NOT be accepted if you do not send these things.

Terms and Conditions:

By giving this information you give your full consent for Princess Melody to fulfill your financial blackmail fetish. Any information you give is voluntary and of your own free will. You agree that the information you have supplied will be used accordingly for the purpose of consensual financial blackmail and give me full permission to use the information and any pictures I request as I see fit for the purpose of this fetish. You understand that there is a 'get out fee' if you no longer wish to pursue this and the fee to pay is $500 USD. Your personal details and any pictures I have in my possession will be destroyed with no further contact from me.

Signature *

Date *

YYYY

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