NFT Minting Customer Details

NFT Minting Form

Customer Details
Please fill in this form with all the required information:*

Walk in CustomerCollected by DealerDealer
Banknotes Receive Date*

DayMonthYear
Pioneer Wallet Address*
Open Metamask Wallet and copy the wallet address
Scan your wallet address QR Code
Pioneer Full Name as NRIC*

SurnameName
Pioneer Mobile Number*

Area CodeMobile Number
E-mail*
Type*

BanknotesCoinsBoth
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*
Upload Picture of (Banknotes/Coins)

Please take a picture of your Banknotes / Coins
Cancelof
Customer Signature*

Clear
Dealer Use
Company Name:*
Dealer Full Name as NRIC
Dealer Mobile Number
Dealer Signature

Clear
Office Use Only
Signature from NumisArt Staff

Clear
Collected by:
NumisArt Staff Name:
Signature from Trigo Staff

Clear
Custody by:
Trigo Staff Name:
Submission Date

DayMonthYear
Should be Empty:

NFT Minting Form