TYPE OF VISA DESIRED:  E-5 Visa E-2 Visa L-1 Visa Green Card

PERSONAL DETAILS:

LAST NAME
FIRST NAME
ADDRESS
STATE, PROVINCE OR REGION
CITY
ZIP OR POSTAL CODE
COUNTRY
COUNTRY OF BIRTH
DATE OF BIRTH
MARITAL STATUS
SPOUSE'S FULL NAME
NUMBER OF CHILDREN UNDER 21

GENERAL INFORMATION:

E-MAIL
HOME PHONE
BUSINESS PHONE
FAX
PASSPORT ISSUED BY
EXPIRES
HAVE YOU EVER VISITED USA? Yes No
IF YES - DETAILS OF VISITS
AND TYPE OF VISA

BUSINESS & FINANCIAL INFORMATION:

COLLEGE DEGREES/DIPLOMAS
CURRENT BUSINESS OR PROFESSION
PREVIOUS BUSINESSES OWNED
DO YOU INTEND TO BE BASED OR ESTABLISHED FULL TIME IN THE USA? Yes No
DO YOU INTEND TO BE INVOLVED IN THE DAY TO DAY MANAGEMENT OF
YOUR NEW ENTERPRISE? 		Yes No
PLEASE INDICATE ANY PREFERENCES AS TO THE NATURE OR TYPE OF SMALL BUSINESS THAT MAY BE OF PARTICULAR APPEAL TO YOU.    KINDLY LET US KNOW WHAT LOCATION WITHIN THE USA IS OF  INTEREST TO YOU TO ESTABLISH YOUR NEW BUSINESS.
Please give full details

PLEASE SPECIFY HOW MUCH YOU CAN INVEST IN YOUR
NEW BUSINESS.

At Least:
$ 50,000 $100,000
$150,000 $200,000
TODAY'S DATE:

Congratulations — You're on your way to the USA!

IMPORTANT NOTICE:      SENDING US THIS FORM IS FOR THE PURPOSE OF CONSULTATION AND EVALUATION AND DOES NOT MEAN THAT YOU HAVE HIRED BUSINESS BROKERS HAWAII, INC. TO REPRESENT YOU.   IF YOU WISH, AND ARE ABLE TO PROCEED, THE COMPANY WILL REQUIRE THAT A RETAINER AGREEMENT IS TO BE ENTERED INTO.
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