Personal information
Name, first name:____________________________________________________
Street/nr: __________________________________________________________
Town/Zipcode: _______________________________________________________
Country: ____________________________________________________________
Phone/Fax: __________________________________________________________
Postaddress: ________________________________________________________
Town/Zipcode: _______________________________________________________
Body form-information
Sex: _______________
Age: _______________
Length: ____________
Weight: ____________
Ordering information
Chastity belt model: Normal _____ Deluxe _____ (from 12/96)
Finish: Mat ___ Polished: ___ (Chemically engraved: ___) Painted: ___
(Gold/silver decoration: ___)
Imitation leather doubled: ___
Chastity-bra: Normal: ___
Sizing list (see drawing templates for numbered size explanation)
1 Waist above hips (at navel level): ________________________
2 5 cm's lower as above: ____________________________________
3 Distance of hipbones across teh back (approx. half the waist):
______________________
Put yourself in a waistbelt at navel, level with a normal tension. Take
following sizes, always starting from navel, and close to the body
Female Male
4 Belt to pubis __________________ Belt to pubis ______________________
5 Belt to clitoris _______________ Belt to penis ______________________
6 Belt to center anus ____________ Belt to center anus ________________
7 Belt to coccyx _________________ Belt to coccyx _____________________
8 Belt to belt ___________________ Belt to belt _______________________
9 * Crotch width (between buttocks) * Crotch width (between buttocks)
________________________ _________________________
Penis length (erect) _______________
Circumference (erect) ______________
* Crotch width means clearance between the legs
To measure the bra, take sizes over a well fitting normal bra
European size of bra+cup: ____________
10 Circumference below breasts, minimum: _______________________________
11 Item but inflated: __________________________________________________
12 Straight nipple distance: ___________________________________________
13 Shoulder strap length: ______________________________________________
14 Across breast vertical: _____________________________________________
15 Item horizontal: ____________________________________________________
Special changes/ special needs/ Corporel limitations:
________________________________________________________________________
________________________________________________________________________
[ Belgian male belt info ]Page last updated 97-Mar-06 by: Altairboy@aol.com