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AriseBank ICO Claim Form
Please fill out the information below. This form is intended to help track down AriseBank ICO contributors, so that they can receive the ArisenCoin (RSN) they would have originally received during the ICO. All original contributors are receiving 4x the amount they would have originally received during the ICO. Make sure all information is accurate.
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Email
*
Your email
First Name:
*
Your answer
Last Initial:
*
Your answer
Email Address Used During ICO:
*
Make sure this is the email address you used to signup for the AriseBank ICO
Your answer
Arisen Username:
*
If you don`t have an Arisen account, you can create one here:
https://signup.arisen.network
Your answer
Original Contribution Method:
*
Bitcoin
Litecoin
Ethereum
Dogecoin
Original Contribution Amount:
*
Make sure you put the entire amount and the ticker symbol of the currency that was used for your contribution i.e if you contributed 1.00000000 Bitcoin, put 1.000000000 BTC.
Your answer
Original Contribution Address:
*
Make sure this is the address you made the contribution from. If you don`t know, just put "n/a".
Your answer
Have You Received A Refund Via The Receiver?
*
YES
NO
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