Forms: Fraud/Scam Investigation Request – CoinMover Bitcoin ATM – Buy Bitcoin with Cash

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Fraud/Scam Investigation Request

Personal Information - Step 1 of 4

Legal Name & Current Address

Please enter your legal name as it appears on your primary identification document along with your current mailing address, your contact information, and your DOB and SSN. Entering as much information as possible will better assist law enforcement in an investigation.

Name *

First

Last

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Date of Birth (DOB) *

Social Security Number (SSN)

E-Mail Address *

Email

Confirm Email

Mobile Phone *

Have you ever been a victim of any theft, scams, or fraud in the past? *

Yes
No

Have you done business with this person(s) in the past? *

Yes
No

Are you still communicating with this person(s)? *

Yes
No

How were you originally contacted by this person(s)? *

Phone
Email
Text Message
Other

Specific to this loss, how many transactions were involved? *

A single transaction
More than one transaction in a single day
Multiple transactions over multiple days

Did you report this to the police or any other law enforcement? *

Yes
No

Please provide the police department, name of a detective, case number, and phone number:

What is the total amount of funds you sent (USD)? *

Which CoinMover kiosk location(s) did you use? *

How did you find the CoinMover kiosk? *

Who did you think you were sending the funds to? *

Describe what happened in detail below:

Do you have contact information from the person(s) who contacted you? *

Yes
No

Please provide all contact information on the person(s) who contacted you (name, email, phone, etc.):

Documentation Upload

Please use the following section to upload any documentation you have that supports your claim. This can include, but is not limited to, an actual police report you filed, any screenshots of any conversations you had with someone else, wallet address codes, etc. If you don't have anything to upload, simply click NEXT to go to the next section.

Upload Document(s) Here

Click or drag files to this area to upload. You can upload up to 10 files.

Signature *

Type your full name in the box above.

Date Signed *

Choose today's date above.

BY SUBMITTING THIS REQUEST, I AGREE THE INFORMATION ABOVE IS ACCURATE AND REPRESENTS ALL THE FACTS ABOUT THIS CASE AS KNOWN TO ME AT THE TIME OF SUBMISSION *

I Agree

Phone

CoinMover is a U.S. Department of Treasury Registered FinCEN MSB #31000188780478. We are fully compliant with all Bank Secrecy Act (BSA), Anti-Money Laundering (AML), and Know Your Customer (KYC) regulations. We offer buying and selling of digital currency at physical locations only.

Contact

330 Lynnway
Lynn, MA 01901
Support: (617) 681-4000
Office: (617) 917-7100
Email: [email protected]

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