Coinbase and Binance Customer Information
Please answer each question that applies to you.
Sign in to Google to save your progress. Learn more
Email *
Name (First and Last) *
You are a customer of: *
If applicable and you recall, approximately when did you first become a Coinbase customer?
MM
/
DD
/
YYYY
If applicable and you recall, approximately when did you first become a Binance customer? 
MM
/
DD
/
YYYY
Do you reside in the United States?  *
Next
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy
Google Forms