EmailMe Form - FinSub Application

Name *
First Last
Age *
Gender
Male
Female
Phone
### - ### - ####
Location *
Twitter Username *
Email *
Monthly Income *
$ Dollars
Sub Photo *
Relationship Status *
Married/In Relationship (aware you are in the Findom world)
Married/In Relationship (not aware)
Single
Tribute Amount *
$ Dollars . Cents
Tribute Frequency *
Daily
Weekly
Monthly
Fetishes *
Hard Limits *
Why should I accept you as one of financial slaves? *
How long will you serve me? How do you wish to do this? *
Safeword *