ZipCoin Pre-ICO Contribution Form
This is the ZipCoin purchase form. The current rate is 8,000 ZIP / ETH , sent to this address: 0x5b6c645389b7013CAc775c01EB670Bb3B735125e

Fill this out after you have bought your ZipCoin. If you do not fill this out, do not worry, you will still receive your ZipCoin, just not any updates or bonuses.

*If you fill out someone else's transaction but your info, you will not receive any rewards and the wallet the transaction came from will be credited.
If there is a wallet with two different forums, the wallet will be credited, with ZipCoin, in the amount spent. Both users claiming it to be there's will receive updates.*

Name *
Your answer
Email *
Your answer
Public Wallet Address *
Your answer
TX Hash *
Your answer
If you were referred, place their username here.
Your answer
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