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ETH Return Form
Please fill out this form to have your ETH returned to you from the Nimbus Token ICO. If you purchased NIM on multiple occasions, you will need to fill out a form for each purchase. For details on the ETH Return Program visit https://nimbustoken.com/return
Email address *
What wallet address did you use to purchase NIM? *
Your answer
What date did you purchase NIM? *
MM
/
DD
/
YYYY
Amount of NIM purchased. *
Your answer
(Optional) Transaction Hash
Your answer
First Name *
Your answer
Last Name *
Your answer
Email Address *
Your answer
Street Address *
Your answer
Street Address (optional)
Your answer
City *
Your answer
State/Provence *
Your answer
Country *
Your answer
Phone *
Your answer
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