Token swap application
Greetings from

the MediBloc team!

We have received continuous requests from holders who failed to proceed with the token swap within the target period, and so we have decided to support the swap for them indefinitely. While MED coins that have not been swapped have been already burned, for holders who have yet to swap their coins, the MediBloc team will still permit doing so by buying swap volume directly from the market.

As always, we'd like to thank all of our holders for their ongoing support. Please be sure to check the swap schedule for the swap, and also be sure to fill out the questionnaire below to apply.

Sign in to Google to save your progress. Learn more
Email *
your QRC20 MED address*(If you are not applicable, please write N/A.) *
your QRC20 transaction hash*(If you are not applicable, please write N/A.) *
your QRC20 token amount you sent*(If you are not applicable, please write N/A.) *
your ERC20 MEDX address*(If you are not applicable, please write N/A.) *
your ERC20 transaction hash*(If you are not applicable, please write N/A.) *
your ERC20 token amount you sent*(If you are not applicable, please write N/A.) *
MED mainnet coin address to deposit MED (*mainnet wallet address starts with “panacea”, exchange address is NOT allowed.) *
In order to send any tokens, please top off the wallet to ensure sufficient QTUM and ETH for the transaction*(at least 1 Qtum, ETH transaction fee is required for each token.) *
Next
Clear form
Never submit passwords through Google Forms.
This form was created inside of MediBloc. Report Abuse