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  1. PLEASE TYPE EVERYTHING IN CAPITAL LETTERS.
  2.  
  3. SHIPPING ADDRESS: FIRST NAME, LAST NAME, ADDRESS, CITY, STATE, AND ZIP CODE:
  4.  
  5.  
  6. ID INFORMATION
  7.  
  8. State:
  9.  
  10. FIRST NAME:
  11.  
  12. MIDDLE NAME [OPTIONAL]:
  13.  
  14. LAST NAME:
  15.  
  16. ADDRESS:
  17.  
  18. CITY:
  19.  
  20. ZIP CODE:
  21.  
  22. EYE COLOR:
  23.  
  24. HAIR COLOR:
  25.  
  26. HEIGHT:
  27.  
  28. WEIGHT:
  29.  
  30. DOB [ON THE CARD]:
  31.  
  32. SEX:
  33.  
  34. LINK TO ID PICTURE [IMGUR.COM]:
  35.  
  36. LINK TO SIGNATURE IMAGE [IMGUR.COM] :
  37.  
  38. (IGNORE IF USING AMAZON) SEND THE BITCOIN/LITECOIN TO: 17Tcq8zoE6ffH2NvNwGrWtsbd97WkWfpcw / LcgDKQAYihSxZJf9XKgS7eX7fKcVQS4AhZ
  39.  
  40. WHAT I NEED FOR PAYMENT VERIFICATION
  41.  
  42. YOUR BITCOIN ADDRESS/LITECOIN ADDRESS/AMAZON GIFTCARD CODE:
  43.  
  44. AMOUNT OF BITCOINS/LITECOINS/AMAZON SENT:
  45.  
  46. COPY AND PASTE COMPLETED FORM TO COLLEGEHELPERUS@PROTONMAIL.COM
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