ESTA U.S. VISA APPLICATION

1. Submit Application Online
2. Review and Confirm Payment
3. Receive Approval Confirmation
All questions must be answered using English-language characters only, except when you are asked to provide your full name in your native alphabet.
Applicant's Basic Information

Enter your Family name exactly as shown in your passport.

Enter your First and Middle Name(s) as shown on your passport.

Have you ever been known by any other names? *

Gender *

* ?
* ?
?
Are you a member of the CBP Global Entry Program? * ?

Passport Information
* ?

Issuance Country must match Country of Citizenship

* ?
Upload Passport* ?

Upload a picture of your passport page that shows your photo and the machine readable zone.

Other Citizenship and Travel Documents
Are you a citizen or national of any other country? * ?

Have you ever been a citizen or national of any other country in the past? * ?

Have you ever been issued a passport or national identity card for travel by any other country? * ?

Applicant's Address
Employment Information ?
Do you have a current or previous employer?*

Travel Information ?
Is your travel to the US occurring in transit to another country? *

Parents' Information ?
If you do not enter one or both parents, UNKNOWN will be used in the application.
Emergency Contact ?
Emergency Contact Information In or Out of US
Eligibility Information
Do you have a physical or mental disorder; or are you a drug abuser or addict; or do you currently have any of the following diseases (communicable diseases are specified pursuant to section 361(b) of the Public Health Service Act): *
  • Cholera
  • Diphtheria
  • Tuberculosis, infectious
  • Plague
  • Smallpox
  • Yellow Fever
  • Viral Hemorrhagic Fevers, including Ebola, Lassa, Marburg, Crimean-Congo
  • Severe acute respiratory illnesses capable of transmission to other persons and likely to cause mortality

Have you ever been arrested or convicted for a crime that resulted in serious damage to property, or serious harm to another person or government authority? *

Have you ever violated any law related to possessing, using, or distributing illegal drugs? *

Do you seek to engage in or have you ever engaged in terrorist activities, espionage, sabotage, or genocide? *

Have you ever committed fraud or misrepresented yourself or others to obtain, or assist others to obtain, a visa or entry into the United States? *

Are you currently seeking employment in the United States or were you previously employed in the United States without prior permission from the U.S. government? *

Have you ever been denied a U.S. visa you applied for with your current or previous passport, or have you ever been refused admission to the United States or withdrawn your application for admission at a U.S. port of entry? *

Have you ever stayed in the United States longer than the admission period granted to you by the U.S. government? *

Have you traveled to or been present in Cuba, Iran, Iraq, Libya, North Korea, Somalia, Sudan, Syria, or Yemen on or after March 1, 2011? *

Agreement
I am electronically signing to authorize ESTA Assist to use the information I provided on this form to apply for ESTA for me. I have read and understood the terms of the Visa Waiver Program. I understand that if my Electronic Travel Authorization (ESTA) is approved, this approval establishes that I am eligible to travel to the United States under the Visa Waiver Program but does not guarantee that I am admissible to the United States. Upon arrival in the United States, I will be inspected by a Customs and Border Protection officer at a port of entry who may determine that I am inadmissible under the Visa Waiver Program or for any reason under United States law. I understand that attempting to obtain an ESTA under the US Visa Waiver Program by the willful misrepresentation of a material fact, or fraud, is an offense. I agree to receive SMS, email, and calls about my order; and to the privacy policy and terms and conditions listed on this website. I also affirm the information listed above is accurate and truthful. I understand that the US Customs and Border Protection (CBP) provides forms and instructions for filings related to ESTA on their website for a fee. However, I request to use the ESTA Assist service to prepare and submit my application based on the information I have provided. I understand and agree that I will be charged for this service in addition to the fee charged by CBP. I understand that ESTA Assist is a third party company and is not associated with any government agency.