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Partner Exchange VIP Placement Order Form.

Xavion Capital arranges preferential VIP tier placement with a partner exchange through our institutional relationships. This form confirms your placement request and the terms of our service. Once submitted, we will send your payment link. Placement begins after payment is confirmed. Everything you provide is treated as strictly confidential.

Section 1: Your details

Full name

Email address

Phone number

Telegram handle

Country of residence

Entity name, if placing as a company

The placement and terms

What you are ordering: Xavion Capital will introduce and place you with a partner exchange at a preferential VIP tier that would not typically be available through standard signup. Our service covers the introduction, expedited approval time, tier placement, and onboarding support when needed. The specific exchange and tier will be confirmed to you directly.

Service scope: I understand that Xavion Capital provides an introduction and VIP tier placement service with a partner exchange, and that this service covers arranging the placement and supporting my onboarding only.

Service scope: I understand that Xavion Capital provides an introduction and VIP tier placement service with a partner exchange, and that this service covers arranging the placement and supporting my onboarding only.

Fee is non-refundable: I understand the placement fee is payable in full before the introduction is made, and that it is non-refundable once Xavion Capital has initiated the placement, regardless of outcome.

Fee is non-refundable: I understand the placement fee is payable in full before the introduction is made, and that it is non-refundable once Xavion Capital has initiated the placement, regardless of outcome.

No guarantee of approval: I understand that final account approval, tier assignment, and all account terms are determined solely by the partner exchange, and that Xavion Capital does not control and cannot guarantee approval, any specific tier, fee level, or feature.

No guarantee of approval: I understand that final account approval, tier assignment, and all account terms are determined solely by the partner exchange, and that Xavion Capital does not control and cannot guarantee approval, any specific tier, fee level, or feature.

Independent relationship: I understand that any account I open is a direct relationship between me and the partner exchange, that Xavion Capital is not the exchange, does not operate it, does not hold my funds, and does not execute trades on my behalf.

Independent relationship: I understand that any account I open is a direct relationship between me and the partner exchange, that Xavion Capital is not the exchange, does not operate it, does not hold my funds, and does not execute trades on my behalf.

My own responsibility: I confirm I am responsible for my own trading decisions and any resulting gains or losses, for my own tax and regulatory obligations, and that I am eligible to open and operate an exchange account in my country of residence.

My own responsibility: I confirm I am responsible for my own trading decisions and any resulting gains or losses, for my own tax and regulatory obligations, and that I am eligible to open and operate an exchange account in my country of residence.

Compliance: I confirm the information I have provided is true and accurate, that my funds derive from lawful sources, and I agree to complete any identity or source-of-funds verification the partner exchange requires. I understand the partner exchange may decline or restrict accounts at its own discretion.

Compliance: I confirm the information I have provided is true and accurate, that my funds derive from lawful sources, and I agree to complete any identity or source-of-funds verification the partner exchange requires. I understand the partner exchange may decline or restrict accounts at its own discretion.

Data sharing: I consent to Xavion Capital sharing my information with the partner exchange for the purpose of arranging this placement.

Data sharing: I consent to Xavion Capital sharing my information with the partner exchange for the purpose of arranging this placement.

Section: Compliance and verification

These are standard anti-money-laundering checks. The partner exchange will run its own verification, and answering these now prevents you paying for a placement that cannot be approved. Answering yes to any question does not automatically disqualify you, it means we review the file before proceeding.

Is any applicant or beneficial owner subject to sanctions, or resident in or a national of a sanctioned country?

Is any applicant or beneficial owner subject to sanctions, or resident in or a national of a sanctioned country?
A
B

Is any applicant a Politically Exposed Person (PEP), or a close family member or associate of one?

Is any applicant a Politically Exposed Person (PEP), or a close family member or associate of one?
A
B

Has any applicant ever been convicted of, or is currently under investigation for, fraud, money laundering, tax evasion, or any financial crime?

Has any applicant ever been convicted of, or is currently under investigation for, fraud, money laundering, tax evasion, or any financial crime?
A
B

Country of nationality

Country of tax residence

Source of the funds used for trading

Passport copy

Proof of address

Sanctions and eligibility: I confirm I am not subject to any sanctions, not resident in or a national of a sanctioned country, and legally eligible to open an exchange account. I understand that if verification shows otherwise, the partner exchange will decline the account, and that Xavion Capital's placement fee remains non-refundable once the introduction has been initiated.

Sanctions and eligibility: I confirm I am not subject to any sanctions, not resident in or a national of a sanctioned country, and legally eligible to open an exchange account. I understand that if verification shows otherwise, the partner exchange will decline the account, and that Xavion Capital's placement fee remains non-refundable once the introduction has been initiated.

Section 4: Confirmation

Signature

Sign with your finger or mouse.

Date of signing

Anything else we should know?