EB-5 Consultation & Evaluation Questionnaire

Business organized as:
Kind of business:
Position:
Duties:
Date of initial investment:

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Amount:
Salary:
Cost of your benefits:
Your total capital invested in business to date:
Percentage of business owned:
County of investment:
State:

Income when you made investment
Gross:
Net:
Now
Gross:
Net:
Net Worth
Gross:
Net:
Number of full-time employees in the business in the U.S. ( Excluding you, your spouse, sons, daughters)
When you made an initial investment?
Now:
Difference:
How many of these new jobs were created by your investment?
How many additional new jobs will be created by your additional investment?
List spouse and children
Full Name
Relationship
Date of Birth

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Full Name
Relationship
Date of Birth

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Full Name
Relationship
Date of Birth

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Full Name
Relationship
Date of Birth

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Full Name
Relationship
Date of Birth

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Should be Empty: