Submissive Application

Submissive Application

18+ Only. Please fill out this form to be considered as a financial submissive. All information will be kept private unless explicitly told otherwise by the submissive.
Name*

NameTwitter Name
Email*
example@example.com
Date of Birth:*

MonthDayYear
Please input a picture of your ID/Passport/Drivers Licence to confirm your information:

You may blurr out all Details except for your picture, Name and Date of Birth.
Cancelof
Location*

Time Zone

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone Number

Country CodeArea CodePhone Number
Do you use:*

TwitterDiscordInstagramSkypeSnapchatOnlyFansWhatsappReal Life MeetsOther
About yourself:
Relationship Status:
Will you pursue other Dommes/Do you already serve other Dommes?

Yes I will/doNo I won't/don'tI don't know for now
If you already have another Domme, write her E-Mail/Twitter Name here:
Names you like to be called:
Kinks & Fetishes:*
Limits:*
What kind of dynamic are you seeking?
How often you wish for contact?
Why does serving me as a finsubs interest you?
A traffic light system will be in place for the safe word . GREEN: Good, YELLOW: Reaching limit, RED: Stop immediately.*

I agree with the traffic light systemI don't agree with the traffic light system
Occupation:
Monthly Salary:*
Payment Methods:*

PaypalBank TransferWestern UnionMoneygramAmazon
Schedule of gifting/sending:

DailyBi/WeeklyMonthlyWhen I canAs directed by Goddess Valeria
How much do you expect to tribute:
Do you desire:*

Tasks/GamesCashpoint MeetsChastitySissificationFoot WorshipAss WorshipVoice CallsVideo CallsExposureDebt/Debt contractsIgnoring/BlockingOther
By clicking on this button you agree that you will willingly submit to Goddess Valeria, offering her control over your mind, body and wallet.*

I accept
By clicking on this button you agree to be devote and loyal to Goddess Valeria.*

I accept
By clicking on this button you agree to like and repost all of Goddess Valeria's posts on Twitter if available.*

I accept
By clicking on this button you agree that you are of sound mind and that you are submitting this application willingly.*

I accept
Please write down any further notes/concerns you have:
Should be Empty: