Application Form
Name
Location
E-mail Address
Age
Marital Status
Single
Married
Separated
Divorced
Girlfriend
Boyfriend
Living with Girlfriend
Living with Boyfriend
Employment Status
Full Time
Part Time
Self Employed
Student
Homemaker
Retired
Disabled
Unemployed
Annual Income
Less than $25,000
$25,000 to $49,999
$50,000 to $74,999
$75,000 to $99,999
More than $100,000
I am applying for Financial Slavery/Domination
How will you serve Mistress Tamika
Daily
Weekly
Every Two weeks
Monthly
Mistress Tamikas prerogative - Human ATM
What is the maximum you can afford - Human ATM's only
How will you make your tributes?
Credit Card
Amazon Gift Certificates
Expand on your answers
Hard Limits: What does not attract you at all
Use the space provided here to give additional information
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