ESTA VISA WAIVER

Step 1 of 7

Applicant Information
First Name*
Last Name*
Gender*
- Male
- Female
City of Birth*

If you do not know the city in which you were born, enter UNKNOWN.
Country of Birth*
Birth Date*

Passport Information
Country of Citizenship*
Passport Number*

The passport number may contain numbers and/or characters. Please closely distinguish between the two, such as the numbers zero and one, and the letters O and I.
Personal Identification Number*

The personal identification number starts with an English letter followed by 9 numbers.
Passport Issuing Country*
Passport Issuance Date*

Day
Month
Year
Passport Expiration Date*

Day
Month
Year
National Identification Number*

Enter the number on your identity document, other than a passport, issued by your country. The National Identification Number, if issued to you, is required to complete the application. If you do not have a National Identification Number, enter UNKNOWN.
Are you a citizen of any other country?*
- Yes
- No
Other citizenship*
Country Passport Number
How did you acquire citizenship / nationality from this country?*
Have you ever been a citizen of any other country?*
- Yes
- No
Which Country?*
From*
To*
Are you known by any other names or aliases?*
- Yes
- No
Aliases*
First Name Last Name
Have you ever been issued a passport or national identity card for travel by any other country?
- Yes
- No
Issuing Country*
Document Type*
Document Number*
Expiration Date*

Day
Month
Year

Contact Information
Applicant E-mail Address*
Enter Email Confirm Email

Enter the e-mail address at which you can be contacted. The e-mail address is required to complete the application. If you do not have an e-mail address, you may provide an alternative third-party e-mail address belonging to a point of contact (e.g. a family member, friend or business associate.)
Telephone Number*
At least one telephone number is required to complete the application. If you do not have a telephone number, you may provide an alternative third-party telephone number belonging to a point of contact (e.g. a family member, friend, or business associate).
Home Address*
Street Address Address Line 2 City State / Province / Region Country
Social Media Information
Please enter information associated with your online presence over the past five years.
Facebook page ID LinkedIn Profile Link Twitter User ID Instagram User ID
If you do not have an account with the listed social media leave blank.
I do not have an online presence
GE Membership
Are you a member of the CBP Global Entry Program?*
- Yes
- No
PASSID / Membership Number*
Parent Information
Parents*
Enter the names of your parents. These are required to complete the application. If you do not know the name of one or both of your parents, enter UNKNOWN, for each parent. This field can include the names of your biological, adoptive, step-parent or guardian.
Father's First (Given) Name Last Name
Parents*
Mother's First (Given) Name Last Name
Employment Information
Do you have a current or previous employer?*
- Yes
- No
Current or Previous Employer
Job Title*
Employer Name*

Enter the name of your current employer. If you are not currently employed, enter the name of your previous employer. Employer name is required to complete the application. You may also enter SELF-EMPLOYED, STUDENT, CHILD, HOMEMAKER, STAY-AT-HOME PARENT, or any other word to describe your employment status.
Address*
Street Address Address Line 2 City State / Province / Region Country
Telephone Number*

Travel Information
Is your travel to the US occurring in transit to another country?*
- Yes
- No
US Travel Information
Name of U.S. Point of Contact*

A U.S. point of contact may be a friend, relative, or business associate. If you do not have a U.S. point of contact, please enter the name, address and telephone number of the location where you plan on staying (e.g. a hotel name).
Point of Contact Address*
Street Address Address Line 2 City State
Point of Contact Telephone Number*
Address While In The United States
Same as previous

Street Address Address Line 2 City State ZIP Code

The address where you will be staying in the US is optional to complete the application. If multiple locations are planned, enter the first address. If the complete address is not known, enter the name of the hotel or location you will visit.
Emergency Contact Information In or Out of the United States
Emergency Contact*
First (Given) Name Family Name
Enter your emergency point of contact who may be a person in or outside of the United States, e.g., a family member, friend, or business associate.
Telephone Number*
Emergency Contact E-mail Address*

Waiver of Rights
Waiver of Rights: I have read and understand that I hereby waive for the duration of my travel authorization obtained via ESTA any rights to review or appeal of a U.S. Customs and Border Protection Officer's determination as to my admissibility, or to contest, other than on the basis of an application for asylum, any removal action arising from an application for admission under the Visa Waiver Program.

In addition to the above waiver, as a condition of each admission into the United States under the Visa Waiver Program, I agree that the submission of biometric identifiers (including fingerprints and photographs) during processing upon arrival in the United States shall reaffirm my waiver of any rights to review or appeal of a U.S. Customs and Border Protection Officer's determination as to my admissibility, or to contest, other than on the basis of an application for asylum, any removal action arising from an application for admission under the Visa Waiver Program.
Certification:*
- I, the applicant, hereby certify that I have read, or have had read to me, all the questions and statements on this application and understand all the questions and statements on this application. The answers and information furnished in this application are true and correct to the best of my knowledge and belief.
WARNING:*
The administrative fee will be collected by credit card. It is crucial that all applicants enter their ESTA and credit card information accurately. If information is entered incorrectly, the applicant may be charged additional fees to reapply. Updates to an application will not accrue additional fees. Applicants who do not complete the payment process will not receive authorization to travel to the United States and will not be allowed to board any aircraft or vessel destined for the United States. If an applicant stops payment of the fee, his or her authorization to travel to the United States will be revoked. We are not responsible for additional fees that may be charged by the applicant's credit card company for the transaction. By pressing the "Submit" button in the application process, applicants agree not to dispute any administrative fee, and further acknowledge that there are no refunds.
- Yes, I have read and understand the information and agree to these terms.
Third Party
- For third-parties submitting the application on behalf of the applicant, I hereby certify that I have read to the individual whose name appears on this application (applicant) all the questions and statements on this application. I further certify that the applicant certifies that he or she has read, or has had read to him or her, all the questions and statements on this application, understands all the questions and statements on this application, and waives any rights to review or appeal of a U.S. Customs and Border Protection Officer's determination as to his or her admissibility, or to contest, other than on the basis of an application for asylum, any removal action arising from an application for admission under the Visa Waiver Program. The answers and information furnished in this application are true and correct to the best of the applicant's knowledge and belief.

ESTA Application
Total
$0.00
Credit Card*

American Express
Discover
MasterCard
Visa
Supported Credit Cards: American Express, Discover, MasterCard, Visa
Card Number Expiration Date Security Code Cardholder Name
Billing Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Country	Passport Number

First Name	Last Name

When	Where

Step 1 of 7

Applicant Information

Passport Information

Contact Information

Social Media Information

GE Membership

Parent Information

Employment Information

Current or Previous Employer

Travel Information

US Travel Information

Emergency Contact Information In or Out of the United States

Do any of the following apply to you? (Answer Yes or No)

Waiver of Rights