Your Name:	Age:
Spouse Name:	Age:
Childrens age(s):
Other dependant living with you:
Address:
City:
State:
Zip/Post code:
Country:
Home Phone:
Work Phone:
Fax:
E-Mail:
Current Business occupation:
Type of business required:
Total Price range:	Choose up to $50,000 $50,000-$100,000 $100,000-$150,000 $150,000-$200,000 $200,000-$250,000 $300,000-$350,000 $400,000-$450,000 Other
Funds available:	Business: Residence: Liquid:
Do you have assets to sell in order to move to the USA? Choose Yes No
If so, please explain:
Do you need an investor's visa for your intended purchase? Choose Yes No
If so, are you familiar with American Immigration Regulations? Choose Yes No
Have you consulted with any visa specialist? Choose Yes No
Comments:

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