Immigration - Miller Mayer

You may fill out this form and submit it to us online, if your web browser supports online forms. If not, or if you prefer not to submit this information over the Internet for confidentiality reasons, you may print out this questionnaire and fax or mail it to us. Please note that information submitted to us over the Internet may not be 100% secure while it is in transit. If this concerns you, please fax or mail the form to us instead of using this online form. Our fax number and mailing address are available in the blue box above.

Once we receive your completed questionnaire we will contact you to schedule your consultation. The fee for most immigration consultations is $300, with higher fees for EB-5 immigrant investor consultations. You may pay by check (payable to Miller Mayer) or by Visa or MasterCard. You must pay before or at the consultation. The consultation fee may be credited toward any flat fee that we agree to for subsequent work done on your behalf, depending on the nature of your case.

Please note and agree to the following by checking the box below:

At this time I have not yet decided to retain the legal services of Miller Mayer nor has Miller Mayer decided to accept my case. Miller Mayer is under no obligation to represent any of the parties mentioned in this questionnaire. Our advice to you can only be based on the facts you give us. We are not liable for failing to give proper advice when we do not know all the facts.

By checking this box, I agree to the terms above.

First Name:

Last Name:

What would you like us to do for you?

Street Address Line 1

Street Address Line 2

City

State

Postal Code

Work Phone

Home Phone

Cell Phone

Fax Number

Your Email:

Birth Date (MM/DD/YYYY) / /

Country of Birth

Current Citizenships/Nationalities

Are you currently in the US?

On what visa did you enter?

Visa expiration (MM/DD/YYYY) / /

What is your current immigration status?

Status expiration (MM/DD/YYYY) / /

Have you ever stayed in the US beyond the time you were authorized to stay?

Yes

Have you ever applied for a U.S. visa, either immigrant or non-immigrant, which application was denied?

Yes

Please list your children (if any are step-children or children by another spouse, indicate which and give further details in the box)

Please list your education and training. Provide the following: names and addresses of schools, main field of study, dates attended, and degrees/certificates received. Or email or fax us your resume.

If you are seeking a visa based on a job, please tell us the name and address of the employer, your job title and job duties.

Have you ever had any problem before with U.S. immigration or police authorities? Have you ever been arrested or fingerprinted for any reason, even if never charged with a crime?

Yes

Please tell us anything you think might be relevant to your situation (e.g. other job offer, fear of persecution, any relatives who are or were US citizens, etc.)

Have you consulted or are you currently consulting other immigration lawyers?

Yes

If you have previously spoken with one of our immigration lawyers, please tell us who and if you would like that lawyer to assist you again.

How did you hear about us? If from the Internet, what search engine did you use?

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