CoinRunners VIP: ICO Contribution form
Please fill out this form after sending your contribution to the ICO as specified in the private Coinrunners forum.
Email address *
Which ICO are you contributing to? *
Full name *
Your real name
Discord username *
Your username from the CoinRunners private Discord forum.
Phone number including country prefix *
For example +12025550173 for US or +441632960127 for UK.
ETH amount invested *
ETH network transaction id
For example 0x60d8e03c9bca4aa6dd34bc5e89878d8e2f6535b26a2542fccbab53ac370f5cd2
Screenshot of withdrawal (If sending from exchange)
If you're sending from an exchange, and they don't show you the ETH network transaction ID, please take a screenshot from the exchange showing confirmation that you withdrew to our wallet address.
Your ETH wallet for the tokens (NOT EXCHANGE!)
Enter your ETH wallet address we should send your ICO tokens to, when we get them. This should be YOUR OWN ETH WALLET that you control the private keys to. For example one you created using MyEtherWallet or Metamask. - NOT an exchange wallet, and NOT an online ETH wallet like or
Please verify that your transaction has gone through
After you've sent, please wait a few minutes (sometimes longer depending on the network speed) and then check if your transaction has gone through. You can do this by going to and copy/pasting your transaction ID in the search field.

If the transaction didn't go through, we will cannot guarantee that we can notify you in time, and your contribution might not be sent to the ICO.

A copy of your responses will be emailed to the address you provided.
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