Enhanced Due Diligence Form

Name*
First Last
Phone Number
Source of Funds / Occupation*
Reason for Buying / Selling Bitcoin*
Supporting Documents Upload
Drop files here or

Accepted file types: jpg, gif, png, pdf, doc, docx.
Optional–Bank Statement, paystub, etc. jpg, gif, png, pdf, doc, docx files allowed.
Are you a US citizen, Non-Resident Alien, or Foreign National?*
Are you involved in any of the following Industries? If yes, please explain.
- Cash-intensive businesses (e.g., convenience store, restaurants, retail stores, liquor stores, tobacco/cigarette distributors, privately owned ATMs, vending machine operators, and parking garages).
- Non-US financial institutions, i.e., bank or foreign money services provider (e.g., casa de cambio, currency exchange, and money transmitter).
- Nonbank financial institutions (e.g., check casher, money transmitter, currency exchange; casinos and card clubs; brokers/dealers in securities; or dealer in precious metals or jewels).
- Foreign corporations, foreign business entities, or offshore corporations.
- Nongovernmental organizations and charities (foreign and domestic).
- Professional services (e.g., attorney, accountant, doctor, real estate brokers).
- Regulated sales of cannabis or cannabis products (medical or recreational).
Are you, or anyone in your immediate family, a senior foreign political figure, either in a foreign country or the US. If so, please explain.*