Employer Basic Information Form

(To be completed by an Employer representative)

Company Information

Street address

Suite, Floor, Bldg., etc.

ignatory Information

Primary Immigration Contact Person

Secondary Immigration Contact Person (if any)

Billing Contact Information

Company Preferences

I certify that the above information is accurate, and that I am authorized by the company 
to provide this information for immigration purposes.

If you have questions about completing this form, please call 248-519-9900.