edd2 | BudgetCoinz Bitcoin ATM's

Name *

Date of Birth (MM/DD/YEAR) *

Email *

Phone *

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

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

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

SSN *

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

What is the purpose of your transaction? *

Please describe the type of investment. *

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.

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?

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 the total amount of funds wired into your bank account? *

What is the total amount of funds sent via check? *

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

Consent *