Embrace the Discipline
*
I am aware that upon filling this out, I am beginning the process to enter into a legally binding, BDSM Debt Contract.
Name
First Name
Last Name
Email
example@example.com
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
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Income & Demographics
Date of Birth
-
Month
-
Day
Year
Date
Employed?
Unemployed
Part Time(less than 30 hrs)
Full Time
Retired
Position:
Gross Income
indicate if weekly, biweekly, monthly, or annual
Income Verification Type
Paystubs (2)
Deposit Screenshot(2)
Annual Tax Forms
Unverified
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Bonded Contacts
If property defaults on contract, the below will be contacted
Contact #1
Name
First Name
Last Name
Email
example@example.com
Phone Number
Please enter a valid phone number.
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Contact #2
Name
First Name
Last Name
Email
example@example.com
Phone Number
Please enter a valid phone number.
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Contact #3
Name
First Name
Last Name
Email
example@example.com
Phone Number
Please enter a valid phone number.
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
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Upload a selfie of you holding your identification or provide link to Yoti or other age verification service below.
Browse Files
Drag and drop files here
Choose a file
Cancel
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Age Verification Link
*
$25 initial payment due
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( X )
USD
Description
Payment Methods
Credit Card
Apple Pay
After submitting the form, you will be redirected to Apple Pay to complete the payment.
Google Pay
After submitting the form, you will be redirected to Google Pay to complete the payment.
Cash App Pay
After submitting the form, you will be redirected to Cash App Pay to complete the payment.
ACH Bank Transfer
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