Chastity Keyholding Contract
Full Name
*
First Name
Last Name
Date of Birth
*
-
Year
-
Month
Day
Date
Postal Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
Format: (000) 000-0000.
E-mail
example@example.com
How did you find us?
*
Please Select
Newspaper
Internet
Magazine
Other (Please specify...)
Titles
*
How long do you wish to be in Chastity?
2 weeks
1 Month
Indefinitely
Unsure
Other
How much experience have you had with Chastity Play?
I'm a Beginner ( Never Tried it)
Intermediate ( casual, weekly wear)
Advanced ( has been caged for several months, without unlocking)
Unsure
Cage Details
For ordering and archiving of your specifications
Cage Model and purchase date
Measurements (Ring diameter, flaccid length, flaccid girth)
Rules and Negotiations
R.A.C.K, S.P.A.N.K and Safe-words used.
Soft and Hard Limits
Contract Negotiation Appointment
Keyholding fee
Bank Name
BSB
Bank Account Number
Back
Next
Official Commencement
Start Date
-
Month
-
Day
Year
Date
End Date
-
Month
-
Day
Year
Date
Signature
Submit
Should be Empty: