Your Existing Order Number: *
New / Modified Order Details:
Sell: *
Pecunix
C-gold
V-Money
Your Gold Account Number : *
Your Gold Account Name : *
Batch Number of your Spend: *
(transaction #)
(If you forgot to copy your Batch/Trasaction Number, look for it in your account History)
Desired Payment Method: *
Swiss Wire (10)
EuroZone Wire (15)
Intl. Bank Wire (45)
US Bank Wire (40) (on top of Sell Fee)
(Euro-Zone wires: Euros ONLY . You MUST provide the IBAN + Swift Code)
Gross Amount sold (US$): *
(99999.99 format)
Example: 1500.25 : Do NOT use «, » (commas) in the Amount sold
Currency of Wire: *
USD EUR CHF
You will receive:
(NET , After Fees)
Personal Details:
Your First Name: *
Your Last Name : *
Your e-mail Address: *
(Land line) Home phone: *
(555-999-1234 format)
Office / Mobile phone: *
(555-999-1234 format)
Your Home Address: *
Your Zip code: *
Your City: *
State: *
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Select your Country: *
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Bank Account Details:
Bank Name: *
Bank SWIFT code: *
(No Spaces)
FULL Bank address: *
(Nb,Street,City,State,Zip,Country)
Bank Acct Number (IBAN): *
(NO spaces, or "-")
Beneficiary Account Name : *
FULL Beneficiary Address: *
(Nb,Street,City,State,Zip,Country)
Modifications Made: *
Additional Info /
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