Company/Resort Name

EIN

Number of Employees

Company Website (optional)

Is this your first time doing the H2B program? Is this your first time doing the H2B program? Yes No

Contact Name

Phone Number (Work)

Phone Number (Mobile)

Company Email

Company Address

Address Line 2

City

State

Zip Code

Worksite Address

Address Line 2

City

State

Zip Code

Projected Start Date

Projected End Date

Acceptance Acceptance I certify that the above information is accurate