Crypto Wallet Recovery Assistance Form

Crypto Wallet Recovery Assistance Form — Form Fields

This finance template includes 11 fields. Request help recovering crypto wallets with platform details and transaction history for support. Free to customize and use on ZenBuild.

• Full Name (text, required)
• Email Address (email, required)
• Phone Number (text, required)
• Wallet Platform (dropdown selection, required) — options: Metamask, Trust Wallet, Ledger, Trezor, Coinbase Wallet, Exodus, MyEtherWallet, Other
• Issue Type (dropdown selection, required) — options: Lost Password/PIN, Lost Seed Phrase, Two-Factor Authentication Lost, Hacked Account, Exchange Locked, Other
• Approximate Date of Last Access (text, required)
• Cryptocurrency Involved (dropdown selection, required) — options: Bitcoin (BTC), Ethereum (ETH), USDT, BNB, Solana, Other
• Approximate Value at Stake ($) (number, optional)
• Screenshot or Transaction Proof (file upload, optional)
• Describe the situation in detail (long text, required)
• Agreement (checkboxes, required) — options: I confirm this wallet belongs to me, I agree to identity verification process