Issue report form
Please fill in this form as accurate as possible, and answer the questions which are relevant to the issue you are reporting. If the information is incomplete, it will delay our feedback.
Email address *
Student's account name *
Your answer
Student's profile-URL *
Your answer
Success coach name *
Your answer
Success coach profile-URL *
Your answer
Country of residence *
Your answer
Description of issue *
Required
Description of issue
Your answer
mobile phone number, incl. country code
Your answer
Mobile Carrier
Your answer
How many empowr coins did you purchase?
Your answer
Which coins are missing
How much did you pay for your coins?
Your answer
Please provide the TxHash (Transaction ID) of your purchase payment
Your answer
Screenshot-URL of the payment confirmation e-mail that includes the transaction ID
Your answer
Which Mission role did you buy?
Your answer
The TxHash of the transfer out fee deducted from your ether wallet
Your answer
The TxHash of the transfer out transaction (if applicable)
Your answer
How many empowr coins did you transfer out? (please provide a screenshot)
Your answer
Screenshot-URL of your balance showing your transfer out request (if applicable)
Your answer
your ether wallet public address
Your answer
Screenshot or link
Your answer
Additional information
Your answer
A copy of your responses will be emailed to the address you provided.
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