Web3 Identity Verification Form
Please complete this form to verify your identity and link it with your Web3 wallet. Your information will be used solely for verification purposes.
Full Name
*
First Name
Last Name
Email Address
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Country of Residence
*
Please Select
United States
Canada
United Kingdom
Germany
France
Australia
India
Singapore
Other
Web3 Wallet Address (e.g., Ethereum, Solana)
*
Select Your Wallet Provider
*
Please Select
MetaMask
Coinbase Wallet
Trust Wallet
Phantom
Ledger
Trezor
Other
Please upload a screenshot of your wallet dashboard displaying your wallet address (hide any balances or sensitive info)
*
Upload a File
Drag and drop files here
Choose a file
Cancel
of
Username or Social Profile (optional, e.g., Discord, Twitter)
Please briefly describe your reason for requesting Web3 identity verification
*
Have you previously completed Web3 identity verification with us?
*
Yes
No
How did you hear about this verification service?
Please Select
Official Website
Community Forum
Social Media
Friend or Colleague
Other
Submit for Verification
Should be Empty: