Request a Paymaster Account

Section 1

Contact information

Full legal name *Email address *Phone number *Role in the transaction *

Section 2

Identity

As it appears on your government documents.

Passport numberCountry of issuePassport issue datePassport expiry dateDate of birthCitizenshipDriver's license numberLicense stateLast 4 of SSN / TIN

Section 3

Residential address

Street address

CityState / ProvincePostal code

Section 4

Employment

EmployerOccupationYears employedEmployer phone

Employer address

Section 5

Legal advisor

Attorney or advisor representing you, if any.

Advisor nameFirmPhoneEmail

Section 6

Business & source of funds

Entity nameEntity typeTax ID / EINJurisdiction of formation

Nature of the transaction

Source of funds

Section 7

Background questions

If you answer yes, add a brief explanation.

Section 8

Documents

PDF or image files, up to 10 MB each.

Passport or government photo IDDriver's licenseTax form (W-9 / W-8BEN)Proof of addressOther supporting document

Section 9

Certification & signature

Your signature is recorded electronically with the date, time and device it was signed from.

Type your full name to certify the above is true and complete *

Draw your signature

Use your mouse, trackpad or finger to sign inside the box.

I agree that my electronic signature above is the legal equivalent of my handwritten signature, and I certify that the information in this form is true and complete. I understand the date, time, IP address and device used to sign are recorded with my submission.

Sign in the box and check the consent statement to enable submission.

This ledger records wires that already occurred at the bank. It never initiates payments and never requests your bank passwords.