Fin Dom Application

Application for Consensual Financial Domination.
The following must be filled out completely for your application to be considered.

Failure to comply will result in your application being denied.

Those who are applying must be at least 18 years of age, NO EXCEPTIONS!
Items with an * are REQUIRED!

Duplicate Applications Will Be Denied!!
Legal Full Name*
Nickname
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Birth Date*

MonthDayYear
Home Number

Area CodePhone Number
Mobile Number*

Area CodePhone Number
Work Number

Area CodePhone Number
E-mail*
Sex*

MaleFemaleTransgender
Orientation*

StraightBi-CuriousBi-SexualOption4
List your fetishes, kinks, desires, wishes; of what you hope to get from the attention of Mistress Coco*
Please list ANY health concerns, medications you are on, allergies you have or anything else that may effect your levels of devotion and health. If None - please insert N/A. *
Which Instant Messaging Services do you use?*
Relationship Status*

SingleMarriedDivorcedLegally SeparatedWidowedOther
If you do have a partner are they aware of your intentions of being Financially Dominated?

YesNo
Are you able to speak, write, read and understand English?*

YesNo
Do you understand that you will be in a Submissive, Slave and/or Pet position to Mistress Coco and at NO SUCH TIME you will be able to dominate Her?*

YesNo
Do you consent to having your private and personal information collected for verification purposes and/or contractual purposes?*

YesNo
Do you consent that you are acting upon your own free will and are not being coerced into applying for Consensual Financial Domination Consideration?*

YesNo
Have you ever been found by a court of law to be legally incompetent?*

YesNo
What type of relationship are you considering with Mistress Coco?*

Srictly Online InteractionStrictly Real Life InteractionWhatever Mistress Coco will allowOnline and Real Life InteractionOption5
What type of Financial Domination are you seeking*

SelectiveCompleteOther
What is your Emplyment Status?*

Employed Full TimeSelf EmployedEmployed Part TimeDisability or Social SecurityOther
Net Income*

up to $2,500 per month$2,500 to $5,000 per month$5,000 to $10,000 per monthGreater than $10,000 per month
How often do you see yourself paying dues or giving gifts to Mistress Coco?*

As Able ToDailyWeeklyAnnuallySpecial Occasions OnlyAs Commanded by Mistress Coco
What monthly responsibilites do you have?*

Child SupportRentMortgageHealth / Life / Vehicle InsuranceAlimonyUtilitiesCable / Satellite / Phone ServicesOther
Please list your responsibilities along with monthly payment amounts below*
Do you understand that this is an application for consideration and it is not intended to be a final acceptance by Mistress until you have been informed that your application has been approved.*

YesNo
Have you falsely represented yourself or intentionally given invalid information on this applicaiton?*

YesNo
Click the following box if you understand that if it is made known or proven that you are engaged in ANY activities of any type of illegal Fraud and/or Identity Theft, that you will be reported to the Local, State, and/or Federal authorities; as well as, all information obtained will be handed over to these agencies involved.*

Agreed
Please upload photo*

Upload a File

Cancelof
Additional Comments you would like Mistress Coco to consider
Should be Empty:

Application for Consensual Financial Domination.