Sign up as a Client – Case Juicy Fields

Welcome. You are about to fill the registration form to be part of Lars Olofsson legal actions second batch. By filling this form, you accept the contract and terms of the agreement.

Please be sure to read the agreement first as you have to pay 200€ by SEPA before filling this form and attach proof of payment.

Prefix

First Name *

Middle Name

Last Name *

Email Address *

Your Telegram ID/Name

Street Address *

Apartment, suite, etc

City *

State/Province

ZIP / Postal Code

Country *

A copy of your ID card or Passport *

No file chosen

How do you came in contact with JuicyFields?

Your JuicyFields payments were in *

FIAT (EUR)Cryptocurrency

How much you've lost *

EUR

Bank Name

City *

State/Province

ZIP / Postal Code

Country *

Please send copies of the transactions of payments sent to JuicyFields. Also Upload here my proof of payment of 200€ fee to Lars *

PaymentDo a SEPA wire transfer with IBAN (displayed in Agreement page)

Your JuicyFields payments were in *

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