Applicant Information
Name:
______________________________________________________
(last)                                (first)                             (middle)

Birthday:______________________________________________
            (month)                        (day)                        (year)

Visa Expiration Date_______________________________________
                              (month)                        (day)                        (year)

Current Status: ___________________(B-2, J-1, F-1, H1B)

Country of birth:________________________________________

Marital Status:                   Married                Single          (circle one)

Address in USA
__________________________________________________

__________________________________________________

__________________________________________________
Foreign Address  (Permanent Residence)

__________________________________________________

__________________________________________________

__________________________________________________

Email_____________________________________________

Telephone in USA___________________________________
Mail completed information to:

Your Travel Agent/Visa Extension
7321 Waukegan Rd.
Niles, IL  60714-4321

If you have questions, please call:
     (800) 841-7353 or
     (847) 647-7750

Checklist:
__This Application
__Passport Copies
  1)  Picture Page in Passport
  2)  Address Information in Passport
  3)  USA Visa in passport
__Copies of all I-94 cards
__Copies of all DS-2019 (J-1 only)
__Last 3 months of bank statements or I-134
__Completed Application
__Letter for visa extension
(URGENT INFO)
  READ HERE OR YOU MIGHT BE DENIED!!!!!

__Fee:  $445 regular processing
      $495  urgent processing within 30days
      $545 EXpress processing within 14days
      $50 each additional family member
__Copy of return airline ticket (
now mandatory
   for all applicants, regardless of status
)  We
   have a program to assist you with your
   ticket.  Ask us for help.
For J-1 Visa Holders:
__Copy DS-2019
__Name of last employer, address and salary