Golden Farm Form:
Fill in this form completely to receive you reward of $5
Your Name:
*
First Name
Last name
Email address:
*
example@example.com
Your Username on Golden Farm
*
Amount of your Replenishment:
*
What kind of Bird(s) you bought?
*
Pay my reward via:
Payeer
Perfect Money
Bitcoin
Your Account Number:
Submit
Should be Empty: