Form I-924 - Application For Regional Center Under The Immigrant Investor Pilot Program Page 2

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Part 3. Information About the Regional Center (Continued)
B. Name of Managing Company/Agency:
Street Address/P.O. Box:
State:
Zip Code:
City:
Telephone Number (include area code):
Web site address:
Fax Number (include area code):
C. Name of Other Agent:
Street Address/P.O. Box:
City:
Zip Code:
State:
Web site address:
Fax Number (include area code):
Telephone Number (include area code):
D. Continuation, if needed, to provide information for additional management companies/agencies, regional center principals, agents,
individuals or entities who are or will be involved in the management, oversight, and administration of the regional center.)
Form I-924 (11/23/10) Page 2

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