Rex Harley's Performer Application

Model Info

I am not offering compensation. This is for fun only!
You will be contacted on where to email your face and nude pics.

Full name as it appears on your proof of age
First name:		Last name:

Stage name:

Birthdate:		Age:

Address
Line 1:
Line 2:
City:		State:
		Zip Code:
Country:

Contact Information
Phone:		Email:

About you
Height
Feet:		Inches:
Weight:
Sexual interests:
Face shot:
Nude shot: