First Purchase Type of Cryptocurrency

Please input your best estimation.

You can change the wallet address you'd like funds deposited to at any time. We check with you before finalizing every trade.

If you answered yes, there are a few additional items we require. Please check the next page.

Please input the full legal name of your business entity.

If you don't have your Articles of Incorporation on hand, you can visit your state's business registry to find a copy.

If you don't have your EIN confirmation letter on hand, please fill out the field below.

The individual submitting this Customer Questionnaire certifies to CoinFlip, as follows:

• By submitting this application, you authorize CoinFlip to make inquiries into the validity of all information supplied within this questionnaire in addition to information otherwise disclosed, both orally or written.
• You certify that the funds used for the transaction are not derived from illegal activity and that the funds received after the transaction will not be used for illegal activity.
• You certify that the cryptocurrency wallet address you provided belongs to you and you only.