Verification

Initial account creation at Hermesbitcoin is performed on our machines. Complete this form only if you have been instructed to do so by Hermesbitcoin Support representative.

    Start - Step 1 of 6

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    Have you already used a Hermes Bitcoin ATM in person? *

    Demographic - Step 2 of 6

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    Legal Name & Current Address

    Please enter your legal name as it appears on your primary identification document along with your current mailing address.

    Name*

    Address*

    Additional - Step 3 of 6

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    Date of Birth & SSN
    Date of Birth (DOB) *

    Social Security Number (SSN) *

    Mobile Phone & E-Mail Address

    If you have not used a Hermesbitcoin ATM before, please enter your primary mobile phone number and e-mail address. If you have previously used a Hermesbitcoin ATM, please input the same mobile phone number you used to receive your SMS confirmation code. If you elected to receive a receipt via email at the machine, please enter the same e-mail address below.

    Mobile Phone *

    Email Address*

    Financial - Step 4 of 6

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    Financial Information

    Being up-front with our customers is a top priority. We ask these questions because government regulations require us to perform due diligence on each of our customers. The purpose is to better understand your financial position and how you obtain the funds you will use with our machines. Please answer the following truthfully and to the best of your knowledge.

    What is your occupation? *

    What is the source of funds you you will use to transact with Hermesbitcoin? (Check all that apply) *

    What is your overall annual income? *

    What is your overall net worth? *

    Are you a Politically Exposed Person (PEP)?

    If you do now know what this question means, you may keep no as the default answer. Politically Exposed Persons (PEPs), also known as "foreign agents" are generally foreign heads of state, ministers, members of parliament, members of the highest court, members of the highest policymaking body auditing international state finances, members of a central bank board, an ambassador or chargé d’affaires, general officer, or executives of a wholly owned state company.

    Document Upload - Step 5 of 6

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    Documentation Upload

    Please select one piece of documentation from each of the three groups below and attach proof. We accept a wide range of formats including camera images from your mobile phone if you do not have a scanner. Any statement, letter, or bill must be dated within the past 90 days. Any insurance policy, mortgage, or tax document must be for the current year.

    Primary Identity Document *

    Primary Identity Document Upload *

    Confirmation - Step 6 of 6

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    Attestation

    I certify that the information contained in this identity verification form is accurate and correct to the best of my knowledge. I affirm that I am the person identified in the documents that have been attached and uploaded on the previous pages. I also agree to the Hermesbitcoin Terms & Conditions, Data Privacy Policy, and the Hermesbitcoin BSA/AML Compliance Policy, copies of which are located in the footer of each page on this website. PENALTY FOR FALSE OR FRAUDULENT STATEMENT: U.S.C. Title 18, Sec. 1001, provides: “Whoever, in any matter within the jurisdiction of any department or agency of the United States knowingly and willfully falsifies, or makes any false, fictitious or fraudulent statements or representation, or makes or uses any false writing or document knowing the same to contain any false, fictitious or fraudulent statement or entry, shall be fined not more than $10,000 or imprisoned not more than five years, or both.”

    Signature *

    Date Signed*