This Form is intended to supply data related to the capabilities of prospective Breukr Investor(s). Kindly complete this form and mail supporting documents for every YES answer to bluechip@breukr.comAfter you fill out this form, we will contact you to go over details before the investment is made.

Breukr STRICTLY PROHIBITS payment of CASH by existing and prospective clients to any representative of the Company, for any reason whatsoever. All payments to the Company shall be by way of cheques or bank drafts issued in the name of the Company or by direct bank transfers or cash payments to the Company’s designated Bank Accounts. The Company shall not be liable for any direct or indirect loss or damage which may arise from failure of the Client to adhere to this directive. If you do not receive any investment notiļ¬cation 48 hours after making payment for your investment, please call Breukr Support (our quick-response Customer Contact Centre) on 0818 857 8245.
 
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