Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.Name *FirstLastEmail *Company or OrganizationAddress *Is the above address for a yourself or your company/organization? *MyselfMy company/organizationPhone number with country code *Why are you requesting custody approval for XIA Coin? *Are you requesting on behalf of yourself, your company or organization, or someone else? *MyselfMy company/organizationSomeone elseHow do you intend to receive XIA Coin (gift, purchase, exchange, etc)? *Have you previously spoken with a representative of XUSD Blockchain Holdings, LLC or one of our partner organizations about obtaining XIA Coin? *YesNoIf you answered "Yes" above, please let us know who you spoke with, and which organization they are affiliated with, so we can verify from our end.Your Stellar Wallet Address(s). Separate wallet addresses using "Quotation Marks". List only the address(s) you would like to have approved for custody, and that are controlled by yourself or the company/organization for which you are applying. *Do you have complete control over this address? *Yes, I have the seed phrase and complete control of the address.No, this is an exchange address.IF you answered NO above, you will need to obtain an address you control.I understandI don’t understand, please send me more information.Submit
