ActaLedger Enrollment Application Form

ActaLedger Enrollment Form

Official Name of Organization/Institution/Agency

Official Corporate Address

Official Website URL (if any)

Name of Current CEO

Official Corporate Email Address

Officially Designated Custodian of the ActaLedger Account

Official Email Address to be used/nominated for ActaLedger Account

Digital Wallet Address for Polygon (Please copy-paste from Wallet)

THIS FORM SERVES AS OUR APPLICATION FOR ENROLLMENT IN THE ACTALEDGER BLOCKCHAIN-BASED DOCUMENT REGISTRATION PLATFORM:

Authorized Official (Full Name) Position in the Organization Signature and Date

[Please print and complete missing information. Have the completed form signed by the authorized approving official. Scan the signed document and send by email to account_manager@actaledger.net.]