1

What is the Green Card Lottery?

2

How to Apply

3

Application

4

Payment Authorization

Application

APPLICANT

Full Name

Last

First

Middle

Place of Birth

City

Province/State

Country

Date of Birth

Day

Month

Year

Country Claimed

SPOUSE

Full Name

Last

First

Middle

Place of Birth

City

Province/State

Country

Date of Birth

Day

Month

Year

CHILDREN (unmarried and under the age of 21)

Full Name

Place of Birth

Date of Birth

(Last, First Middle)

(City, Province/State, Country)

(Day/Month/Year)

o If you wish to list additional children, please check the box on the left and provide their information on the back of this form.

CONTACT INFORMATION

Address

PHOTOGRAPH

Applicant’s photograph should be approximately the size of this box.

City

Province/State

Country

Postal Code

Telephone

Email

APPLICANT’S SIGNATURE

X

Payment Authorization
(complete only if paying by credit card)

APPLICATION TYPE

ٱ  Individual ($15JD)

ٱ  Dual ($10 USD)

Please send your application to this address :

Amman-Jordan- SportCity- P.O.Box:960811 – ZipCode:11196 .

AgentGreenCard – Mr.M.Amin Alsabah

TEL MOBILE : 962-795216921

We Accepted Cash Money – Travel Checks – banking Cheks.

Credit Cards : Credit Master – Visa – American Express .

TERMS AND CONDITIONS

I agree to pay USA Green Card for services related to the preparation and submission of my Diversity Immigrant Visa ("Green Card") Lottery application. I further acknowledge that USA Green Card does not guarantee that I will receive a permanent US residence/work visa, but only provides me with an opportunity to participate in the Green Card Lottery. Because this is a lottery program, I understand that I cannot claim a refund for fees paid to process my application.  By signing below, I accept these terms and conditions and agree to pay the above processing fee according to my card issuer agreement.