Cryptocurrency ATM Identity Verification Form
Provide the information needed to verify your identity before using the cryptocurrency ATM. Complete all required fields accurately so your verification can be reviewed.
User Information
Full Legal Name
*
First Name
Middle Name
Last Name
Date of Birth
*
-
Month
-
Day
Year
Date
Country/Region of Residence
*
Please Select
United States
Canada
United Kingdom
Australia
New Zealand
Other
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email Address
*
example@example.com
Preferred Contact Method
*
Email
Phone
SMS
Identity Verification Details
Document Type
*
Passport
National ID
Driver’s License
Residence Permit
Other
Country or Region of Issue
*
Please Select
Afghanistan
Albania
Algeria
Andorra
Angola
Argentina
Armenia
Australia
Austria
Azerbaijan
Bahrain
Bangladesh
Belarus
Belgium
Bolivia
Bosnia and Herzegovina
Brazil
Bulgaria
Canada
Chile
China
Colombia
Croatia
Cyprus
Czech Republic
Denmark
Egypt
Estonia
Finland
France
Georgia
Germany
Greece
Hong Kong
Hungary
Iceland
India
Indonesia
Ireland
Israel
Italy
Japan
Kazakhstan
Kenya
Latvia
Lithuania
Luxembourg
Malaysia
Mexico
Morocco
Netherlands
New Zealand
Nigeria
Norway
Pakistan
Peru
Philippines
Poland
Portugal
Romania
Saudi Arabia
Singapore
Slovakia
Slovenia
South Africa
South Korea
Spain
Sweden
Switzerland
Thailand
Turkey
United Arab Emirates
United Kingdom
United States
Ukraine
Other
Document Expiration Date
*
-
Month
-
Day
Year
Date
Is the Document Currently Valid and Unexpired?
*
Yes
No
Upload Document Photo (Front and Back if Needed)
*
Upload a File
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Crypto ATM Transaction Readiness
Intended ATM Action
*
Buy cryptocurrency
Sell cryptocurrency
Other supported ATM action
Estimated Transaction Amount (USD)
*
Intended Currency or Asset
*
Please Select
Bitcoin (BTC)
Ethereum (ETH)
USDC
Litecoin (LTC)
Other
Source of Funds
*
Please Select
Cash on hand
Personal savings
Business funds
Gift or transfer received
Crypto holdings
Other
Acknowledgment
*
I understand the ATM may require additional verification before completing the transaction
I understand transaction limits may apply before completing the transaction
Verification Review
Verification status
*
First-time user
Returning user
Needs manual review
Self-attestation provided
Other
Selfie or live photo
Upload a File
Drag and drop files here
Choose a file
Cancel
of
Additional notes or special circumstances
Submit Verification
Should be Empty: