ERROR:
JavaScript is not enabled. You must enable JavaScript in your browser to use this form
Please fill in a valid value for all required fields
Please ensure all values are in a proper format.
Are you sure you want to leave this form and resume later?
Are you sure you want to leave this form and resume later? If so, please enter a password below to securely save your form.
Save and Resume Later
Save and get link
You must upload one of the following file types for the selected field:
There was an error displaying the form. Please copy and paste the embed code again.
Apply Discount
You saved
with code
Submit Form
Submitting
Validating
There was an error initializing the payment processor on this form. Please contact the form owner to correct this issue.
Please check the field:
Fields
Name
*
First Name
*
Last Name
*
Location
*
City
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virgin Islands (US)
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces (the) Americas
Armed Forces Europe
Armed Forces Pacific
Army Post Office (U.S. Army and U.S. Air Force)
Fleet Post Office (U.S. Navy and U.S. Marine Corps)
State
Age
*
Email
*
Phone
*
We will not give your your info to anyone - but having your number is very helpful if we want to reach out to you for a story
Occupation
Did you invest in crypto using FTX or other platforms?
*
FTX
Other platforms
FTX and other platforms
Did you lose the ability to access your money/ holdings on FTX?
*
Yes
No
I'm not sure
FTX froze customer accounts after the company essentially collapsed.
How much money and are you worried you may never get it back?
*
Tell us what’s happening.
What sorts of crypto currencies were / are you investing in?
(Bitcoin, Ethereum, Binance, etc)
What other platforms were you investing on (besides FTX?)
Overall, by investing in crypto have you made or lost money?
*
How much? And was this a significant investment/financial blow or just a small wager?
What led you to start investing in cryptocurrency and how long have you been doing it?
*
Did you see TV ads or have friends who made money or what got you into it? Take the time you need to tell us the story of what happened.
What is your experience as an investor? For example, have you been investing for 20 years and crypto is just a small part of your much more diversified portfolio, or was this your first experience as an investor?
Tell us generally what it’s been like for you to invest in crypto. Did you feel you understood the risks going in? Was the experience good, bad, ugly?
*
Is there anything else you’d like to share with us about your experience?
What is your race/ ethnicity?
Previous
←
Next
→
Enter your save and resume password
Cancel
Confirm