Contact Information
Save time by completing your verification in advance. Once approved, you'll be able to purchase up to $50,000 per day at any CustomersChain OTC desk.
Full Name
Email
Phone Number
VoIP numbers are not accepted.
Address
Help us verify your identity by providing your current residential address and personal details.
Address Line 1
Address Line 2
City
State
Select your state
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Zip Code
Date of Birth (DOB)
Tax ID (SSN or EIN)
Upload front of ID
Upload back of ID
Photo of the front (showing all four corners) of a current government-issued ID. If you are a US citizen, you may use your state issued Driver’s License or ID.
File format allowed: .jpg, .jpeg, .png or .pdf and must not exceed 5MB in size
Photo of the back (showing all four corners) of a current government-issued ID. If you are a US citizen, you may use your state issued Driver’s License or ID.
File format allowed: .jpg, .jpeg, .png or .pdf and must not exceed 5MB in size
Upload Selfie
Selfie
Please provide a photo of yourself holding a handwritten note that includes your full name, today's date, and the words "CustomersChain OTC"
Additional Information
To complete your registration for CustomersChain white glove OTC desk Services, we require a few final details.
Are you a US citizen, Non-Resident Alien, or Foreign National?
US Citizen
Non-resident Alien
Foreign National
How much cryptocurrency would you like to buy?
0-10K
10K-50K
50K-100K
100K+
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.
Source of Funds / Occupation
Are you involved in any of the following Industries?
No, I am not involved in any of the things listed below.
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).
Reason for Buying / Selling Bitcoin
Optional: Supporting Documents Upload
Submit
