Enhanced Due Diligence

Name *

First

Last

Phone *

Year of Birth *

Email *

Occupation *

How did you obtain your wallet? (barcode that you scan) *

What platform/website did you use to create your wallet? *

What is the purpose of your transaction? *

Do you plan on purchasing or sending more than $3,000 in a single day? *

Social Security Number (SSN) *

Please describe the type of investment. *

Are you or will you be sending money to someone else? *

Please describe how you were contacted by the IRS. *

Please describe how you were contacted by the US Marshall's.

Please describe how you were contacted by law enforcement.

Please describe how you were contacted to pay your utility bill/electric bill.

What is your relationship to the person who is receiving the cryptocurrency being purchased? *

What is his/her name? *

First

Last

What country is the person receiving the bitcoin located in? (i.e. Nigeria, Italy) *

What is the family relationship? (e.x. aunt, cousin) *

How long have you know them? *

How did you meet? *

Have you met face to face? (In Person)

When was the last time you saw each other? *

What is the total amount of money you plan on sending to this person? *

Please describe the purpose of the funds: *

What is the source of funds being used to purchase the cryptocurrency? *

What is your expected monthly volume of purchases to this wallet? *

Past 6 months - Bank Statements (Required for Approval) *

Click or drag a file to this area to upload.

Consent *

Customer Questionnaire