SC - US Visit Request Form

FCA has teammates from around the world who visit the USA at different times throughout the year. All of these visitors coming to the USA are requested to complete this form so that we can best assist you. Note: Blanks with an asterisk (*) are required fields.

First Name (as shown in Passport)*

Middle Name(s)

Surname - Family Name(s)*

Date of Birth*

Passport Number*

Country issuing passport*

Passport Expiration Date*

Write here the following: 1) Purpose for your trip. 2) Write a brief outline of your desired travel itinerary. Please include all places you plan to visit in the USA along with the approximate dates.*

Date of Arrival in USA*

Date of Departure from USA*

Departure Airport (Name of City and Airport Code)*

Attached a copy of your current passport.*

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