Welcome to the BlockGrain Token Sale Registration (Part 1 of 2)
This registration form will guide you through the KYC ("know your customer") process and enable you to whitelist your Ethereum Wallet Address.

Ethereum Wallet Addresses that have not been whitelisted will not be able to participate in the BlockGrain Public Token Sale.

For further information about the BlockGrain Public Token Sale, please visit: www.blockgrain.io

For any assistance with your registration, please contact: support@blockgrain.com.au
Start
 
What is your first name? *

Must match the first name on your ID.
 
What is your last name? *

Must match the last name on your ID.
 
What is your mobile phone number? *

Please include your country code
 
Whitelisting an Ethereum Wallet Address *

Your Ethereum Wallet Address will need to be added to the whitelist. Your specified Ethereum Wallet Address MUST be:

• the Wallet Address from which you will send Ether; and
• the Wallet Address that AGRI tokens will be sent to.

Your specified Ethereum Wallet Address MUST NOT BE ON A PUBLIC EXCHANGE! AgriChain Pty Ltd is not responsible for any tokens lost if sent to a Public Exchange Wallet Address you have specified.
Your Ethereum Wallet Address will need to be added to the whitelist. Your specified Ethereum Wallet Address MUST be:

• the Wallet Address from which you will send Ether; and
• the Wallet Address that AGRI tokens will be sent to.

Your specified Ethereum Wallet Address MUST NOT BE ON A PUBLIC EXCHANGE! AgriChain Pty Ltd is not responsible for any tokens lost if sent to a Public Exchange Wallet Address you have specified.
     
 
What is the Ethereum Wallet Address you want to whitelist? *

DO NOT USE A PUBLIC EXCHANGE WALLET ADDRESS!

Please be careful to ONLY share your public ETH Wallet Address!
A typical ETH Wallet Address looks like this... 0x4a575b463cd930ba37df3aac020203cc94867ba4
 
(Optional) Bitcoin Wallet Address

As an alternative, BlockGrain is also allowing contributions in Bitcoin.

**Please note** that you still need a valid ETH Wallet in order to receive your ERC-20 compliant AGRI Token.

If you would like to contribute in Bitcoin (BTC) then please specify the exact Bitcoin Wallet Address below.
 
What is your anticipated contribution (in ETH)? *

 
(Optional) Referral code

 
Where did you hear about BlockGrain? *

You have now completed Stage 1 of the BlockGrain Token Sale Registration.

You will receive an email shortly confirming your ability to send ETH / BTC to the BlockGrain Token Sale.

This DOES NOT mean that you are exempt from completing stage 2 of the white list

PLEASE NOTE – TO RECEIVE AGRI YOU MUST COMPLETE PART 2 OF THE KYC FORM BY THE END OF JULY 1ST AEST.

FAILURE TO DO SO WILL EXCLUDE YOU FROM THE SALE!

To complete Part 2 of the KYC please go to - https://blockgrain.typeform.com/to/Mp7C95

You will need
- Valid Proof of address document
- Current Photo I.D (Valid Drivers License or Passport)
- Ability to take a selfie

For any assistance please contact: support@blockgrain.com.au

Thank you,
The BlockGrain Team
Proceed to KYC Part 2