US Travel Waiver Application Form

Fill in your information, below. Click the SUBMIT button at the bottom of the form to send us your information.

If you have questions or problems, please contact us:

1-866-997-2736 or 250-307-7104

Full Name

First Name Last Name

Other names (maiden name, previous married name(s), legal name change)

Your Sex

Male Female

Birth Date

Month Day Year

City & Country of Birth

Your Mailing Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country

Your Physical Address (if Different)

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country

How Long at This Address? Select Date You Moved In

Month Day Year

Home Phone Number

Area Code Phone Number

Cell Phone Number

Area Code Phone Number

Work Phone Number

Area Code Phone Number

Private E-mail

Father's 1st & Last Names

First Name Last Name

Father's Birth Date

Month Day Year

Father's City & Country of Birth

Father's City & Country of Residence

Mother's 1st & Maiden Names

First Name Last Name

Mother's Birth Date

Month Day Year

Mother's City & Country of Birth

Mother's City & Country of Residence

Spouse's 1st & Maiden Name

First Name Last Name

Spouse's Birth Date

Month Day Year

Spouse's City & Country of Birth

Date & Place of Marriage

Date & Place of Divorce if Applicable

Former Spouse's 1st & Maiden Name

First Name Last Name

Former Spouse's Birth Date

Month Day Year

Date & Place of Marriage

Date & Place of Divorce

Employment in last 5 years: Full name and address of employer, dates employed, and occupation

Purpose for Entering the US:

Previous filing for permission to enter the US

Yes No

Were you denied permission to enter the US

Yes No

Date & Location

If in US for 6 mos or more, when, how long & what immigration status

Have you ever, in or outside the US, been arrested, charged, fined or imprisoned for breaking or violating a law?

Yes No

Describe all offences where impaired driving was an issue

How would you like to be contacted?

Are members of your household aware of this application?

Drivers License # and Province of issue

All addresses lived at in the last 5 years

Dates and locations of all convictions: (Alberta court fee will apply)

Have you ever been detained and denied at the border? When & details

Personal Information for U.S. Travel Waiver

1-866-997-2736 or 250-307-7104