Name *

Email *

Company *

Business Email *

Your official email address at your business website's domain

Business Website *

Business Type/Model *

Select the option that best describes your business

Select an option... Consumer Card Platform/Marketplace Digital Asset Exchange Digital Asset Wallet/Fintech Traditional Fintech (No Digital Assets) DeFi Unregulated Exchange Stablecoin Issuer or Stablecoin Ecosystem VPN / Privacy Tools Protocol / Alt Coin Mining / Mining Pool Shopper as a Service Cards as a Service (Distributor) Payments as a Service Artificial Intelligence API-Enabled Business Travel Agent or Travel Purchasing Platform Custom App Consultant / Technology Developer

Business Overview *

Please describe your business. What product or service do you offer? Why are you the preferred partner for your customers? Who is your competition?

Revenue Model *

What do you charge your customers? How do you make money? (fee, spread/FX, subscription, markup, other)

Capital *

How much capital has your company raised? ($0 if None)

Budget *

How much capital have you allocated to launching cards?

Monthly Volume *

What transaction volume do you anticipate in month 6 of the program?

End-Customers *

Marketing Channels

Please provide your social media handles

How do customers interact with your business? *

Select all that apply

What information is captured during user signup? *

Select all that apply

Full Legal Business Name *

Country of Incorporation *

Full Legal Name of Authorized Signer *

Authorized Signer Email *

Authorized Signer Country of Residence *

Authorized Signer Nationality *

Phone Number