I agree and to provide Countess Naomi with the below personal information for the purpose of being of being consensually blackmailed. By filling out this form I agree that I do this of my own free will. I am providing the following information voluntarily. I have not been coerced or defrauded into providing such information and understand that release of this information by Countess Naomi will be of her own discretion. Once this document is filled out and electronically signed, all information is the sole property of Countess Naomi and she can do with it as she wishes. The Consensual Blackmail contractual period has no expiration. I understand that Countess Naomi will own me and own my information for as long as she likes.
I further agree to explicitly follow her instructions. I understand that failure to follow such instructions will invoke the release of any or all of the information provided below to the designated parties below.
Full Name:
Address:
City / State / Zip:
Home Phone:
Cell Phone:
Email:
Myspace Page:
Facebook Page:
Age:
Erect Cock Size:
Marital Status:
Place of work: (e.g. Home or Office)
Name of Company:
Address:
City/State/Zip:
Your Position at Company:
Company Website:
Work Phone Number:
Boss' Name:
Boss' Phone Number:
Wife or Girlfriend's Name:
Cell Phone Number:
Email:
Ex-wife or Ex-girlfriend's Name:
Cell Phone Number:
Email:
Your Sexual Secrets:
Most Embarrassing Sexual Moment (as an adult):
1. Write an Email to your Wife or Girlfriend outlining your sexual secrets
2. Send photo proof of your sexual secrets
3. Send a regular photo or cam capture of you
Annual income:
Assets:
Toys(example: motorcycle, wide screen tv):
Collections:
Expenses:
Amount you can tribute monthly to your Mistress:
Dates on which tributes can be tendered:
________________________________
Type in Full Name Above
______________
Date
NOTE: All tributes must be tendered thru Niteflirt. There are no alternative payment methods!
INSTRUCTIONS: Cut & Paste this text into an email and send to me at:
countessnaomi@gmail.com
Include everything requested in the Application or your Application will be rejected and your Application Fee will be forfeited to me, Countess Naomi.
