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BIG UPDATE
New thread will be made today in a few hours. The form is written and ready to go. I'm revising the pastebin in a bit.
IMPORTANT:
In order for the form to collect the image used in your proof of address you need to be logged into your google account or make one. The only way around this would be for you to upload the image somewhere and then send me the link. It would be more work for you and me sorting through that.
Since most people have gmail, and I expect most people will use a gmail account anyway when they submit their email address I decided it's not a big deal. When you send the picture, I will see the name of your google account, which, if you send me an email with your gmail account I would see anyway. You can also just make a brand new account too.
Is this a big deal for anyone? I honestly think it's fine, but let me know now.
Pic related is how the form looks. If you see a typo, tell me.