Blank personal token burn template

gistfile1.txt

<%
[[Token Burn Amount: Number "How many *Token* are you redeeming?"]]
[[*Token* Redeemer Email: Identity "What is your email to sign off on this?"]]
[[*Token* Redeemer EthAddress: EthAddress "What is your MetaMask address holding *Token*?"]]
%>
<%
[[id:Identity("*Your Email Address*")]]
%>
<%
[[@Hours Engaged = Token Burn Amount]]
[[@Token Burn Amount in Wei = Token Burn Amount * 1000000000000000000]]
%>
<%
[[Redeem *Token*:EthereumCall(
contract:"*Your token Contract*";
interface:[{"constant": false, "inputs": [{"name": "account", "type": "address"},{"name": "amount", "type": "uint256"}], "name": "mint", "outputs": [{"name": "", "type": "bool"}], "payable": false, "stateMutability": "nonpayable", "type": "function"},{"constant": false, "inputs": [{"name": "amount", "type": "uint256"}], "name": "burn", "outputs": [], "payable": false, "stateMutability": "nonpayable", "type": "function"}];
network:"Mainnet";
from:*Token* Redeemer EthAddress;
function:"burn";
arguments:Token Burn Amount in Wei)]]
%>

\centered **__REDEEM *Token*__**

The undersigned commits a burn of *Token* (ERC20) in order to retain *Your Name* in the following manner:

| ❂ | Details | 
| --------- | --------- | 
| Burn Amount | [[Token Burn Amount]] |
| Hours Engaged | [[Hours Engaged]] |

[[Redeem *Token*]]
__*[[*Token* Redeemer Email: Identity | Signature]]*__
0x[[*Token* Redeemer EthAddress]]

\pagebreak

*Your Name* confirms the *Token* redemption described above and shall provide a Legal Engineering consultation by means of electronic communication (*Zoom, Google Hangouts, Skype, Discord etc.*) in the month timestamped by the signature below:

__*[[id | Signature]]*__

'''The Parties hereto agree that the following *Token* Redemption and related 'Legal Engineering' consultation(s) are not intended to create, and such redemption does not constitute, an attorney-client relationship.'''