Form I-924 - Application For Regional Center Under The Immigrant Investor Pilot Program Page 6

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Part 5. Signature of Person Preparing This Form, If Other Than Above (Sign Below)
I declare that I prepared this application using information provided by someone with authority to act on behalf of the Regional
Center, and the answers and information provided by the Regional Center.
Attorney or Representative: In the event of a Request for Evidence (RFE), may the USCIS contact
Yes
No
you by Fax or E-mail?
Printed Name of Preparer
Date (mm/dd/yyyy)
Signature of Preparer
Firm Name and Address
Daytime Phone Number
Fax Number (Area/
E-Mail Address
(Area/Country Codes)
Country Codes)
Form I-924 (11/23/10) Page 6

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