Coinbase and Binance Customer Information
Please answer each question that applies to you.
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Email *
Name (First and Last) *
You are a customer of: *
If applicable and you recall, approximately when did you first become a Coinbase customer?
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If applicable and you recall, approximately when did you first become a Binance customer? 
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/
DD
/
YYYY
Do you reside in the United States?  *
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