Blackmail Form

Blackmail Form
Name*

First NameLast Name
E-mail*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Marital Status*
Significant other's email (if applicable)
Twitter ID
Facebook Link
Your profession*
Your monthly Income*
Sexual Kinks/Fetishes*
Limits (if any)*
Dark Secrets
Attach Photo of you holding sign "I wish to be blackmailed by Goddess Anastasia."*

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Attach proof of age (i.e. driver's licence) Note: this info will NOT be published and will remain private*

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Terms and Conditions:

You providing this information is giving Goddess Anastasia full consent to engage in financial blackmail fetish with you. Any photos or information is given voluntarily. By clicking the box, you are acknowledging that the information you have provided is for the sole purpose of consensual financial erotic blackmail, also known as sextortion. By submitting this, you are giving me permission to use your information and photos as I please to indulge your fetish. You also understand that there is a 'mercy fee' if you no longer wish to continue of $100 USD. Your personal details and photos will be deleted and destroyed and I will no longer contact you.
Consent*

I agree to the above terms and conditions
Signature*
Date*
Should be Empty:

Terms and Conditions: