It is fully understood and accepted by you that this is not a Contract of prostitution. It is also fully agreed to, and by you that under NO CIRCUMSTANCES whatsoever are sexual intercourse, fellatio or hand job solicited, offered or available from me at anytime.  I also do not offer nude or topless sessions so don't ask.
 

Personal Info:

Name
Age
Sex Male  Female
Height
Weight

 Contact information:

Type of work
Contact Phone              * required
E-mail              * required

Dates of Interest:

Do you have any medical situations or medical limitations ect? (Are you on any medications, etc.)?

Have you played before? Have any References?  If so let me know the name you used to contact them:

Where did you see my contact info/website?

What type of Dominance do you require:
Light   Medium   Heavy

Does the feeling of helplessness excite you? Yes  No

Does the feeling of being punished excite you? Yes No

List your hard limits.  I respect them as places you have no intention on going. 

Briefly state your primary area of interest:

Describe your fantasy. This will give me insight into what you are looking for and where your mind is. This is in no way to be considered a script but insight into where you come from and where you wish to go.