NFT Minting Form
Customer Details
Please fill in this form with all the required information:
*
Walk in Customer
Collected by Dealer
Dealer
Banknotes Receive Date
*
/
Day
/
Month
Year
Pioneer Wallet Address
*
Open Metamask Wallet and copy the wallet address
Scan your wallet address QR Code
Pioneer Full Name as NRIC
*
Surname
Name
Pioneer Mobile Number
*
-
Area Code
Mobile Number
E-mail
*
Type
*
Banknotes
Coins
Both
Total Pieces
*
Please select the type before filling in the banknotes quantity
Total Amount
Total amount need to pay by customer
Total in USDT
Total amount USDT in your wallet address
Total in BNB
Total amount BNB in your wallet address
Bank Notes Status
*
Please Select
Store in Company as custody
Return to Owner/Customer
Upload Picture of (Banknotes/Coins)
Browse Files
Drag and drop files here
Choose a file
Please take a picture of your Banknotes / Coins
Cancel
of
Customer Signature
*
Dealer Use
Company Name:
*
Please Select
CN Stamp and Coin Note Collections
Junior K Express Enterprise
KPNN
Million Hartamas Sdn Bhd
Monetarium (S) Pte Ltd
007 Numis Trading
Dealer Full Name as NRIC
Dealer Mobile Number
Dealer Signature
Office Use Only
Signature from NumisArt Staff
Collected by:
NumisArt Staff Name:
Signature from Trigo Staff
Custody by:
Trigo Staff Name:
Submission Date
/
Day
/
Month
Year
Submit
Should be Empty: