Payment Verification Form

Payment
Verification Form

Please return the following form along with the identification documents listed below:

1. Photo of ID (back and front in color);
2. Photo of the credit card used (back and front in color). The Company requires only the first 6 and last 4 digits, the expiration date, the card holder's name, and the signature (optional). The rest can be covered;
3. Card verification form for each card used for deposits;
4. Utility bill (or any other official document, containing player's current physical address and full name on it), issued within 3 (three) months.

Documents to be submitted via email: [email protected]

Bank Name State of the issuing bank Account Holder’s Name Account Number

ABA Routing Nº for wire transfer ACH Routing Nº for Paper and Electronic Transfers

Branch Code (NZ) SWIFT/BIC Code BSB Number (AU/NZ) Bank/sort code (Canada/UK/NZ) Transit ID (Canada) IBAN Number (Europe) Bitcoin Wallet Address (not Cash App)

*To validate the accuracy of bank details VOID check or screenshot of your online banking might be requested.

All withdrawal requests must first be reviewed and approved by the casino finance department before being sent for payment.

We record and store all interactions between the customers and the company. This record shall be used in case a dispute arises between the customer and Two-Up as a guarantee of its successful resolution. Please note that Two-Up is not liable for the accuracy of the beneficiary detail submitted in the form. By placing the signature below, you therefore acknowledge the credibility of the information provided and agree to act in accordance with the Terms and Conditions.

Signature

Date