Withdrawal Requests

PayPal Address

Bitcoin Address

Full Name *

Billing Address Line 1 *

Billing Address Line 2

Billing Address Line 3

City *

State

Postcode *

Country *

Bank Account Holder's Name *

Bank Account Number/IBAN *

SWIFT Code *

Bank Name in Full *

Bank Branch City *

Bank Branch Country *

Intermediary Bank - Bank Code

Intermediary Bank - Name

Intermediary Bank - City

Intermediary Bank - Country

Owner Name *

Bank Name *

Bank Agency Number *

Bank Account Number *

CPF *

Account Type * Checking Account * Savings Account *

Nome *

Cognome *

Codice fiscale *

Sesso *

Numero di telefono *

Via/Piazza e numero *

Codice postale *

Città *

Provincia *

Paese *

Nome di banca *

IBAN *

BIC/SWIFT *

First Name

Last Name

Bank Name

Account Number

Sort Code

Owner Name *

Bank Name *

IBAN *

Bank Account Number *