apec.globalentry-online.com
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2a06:98c1:3120::3
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URL:
https://apec.globalentry-online.com/apply
Submission: On February 20 via manual from MX — Scanned from NL
Submission: On February 20 via manual from MX — Scanned from NL
Form analysis 1 forms found in the DOM
POST /Global-Entry/Application
<form action="/Global-Entry/Application" class="row" role="form" id="CustomerIndexForm" method="post" accept-charset="utf-8" novalidate="novalidate">
<div style="display:none;"><input type="hidden" name="_method" value="POST"></div><input type="hidden" name="data[Customer][application_type_id]" class="form-control" value="1" id="CustomerApplicationTypeId"><input type="hidden"
name="data[Customer][utm_source]" class="form-control" value="direct" id="CustomerUtmSource">
<div class="col-md-4">
<div class="form-group form-register required"><label for="CustomerLastName">Last Name<span class="astrisk">*</span></label><input name="data[Customer][last_name]" class="track-input-lastname form-control" required="required" maxlength="255"
type="text" id="CustomerLastName"></div>
</div>
<div class="col-md-4">
<div class="form-group form-register required"><label for="CustomerFirstName">First Name<span class="astrisk">*</span></label><input name="data[Customer][first_name]" class="form-control" required="required" maxlength="255" type="text"
id="CustomerFirstName"></div>
</div>
<div class="col-md-4">
<div class="form-group form-register"><label for="CustomerMiddleName">Middle Name</label><input name="data[Customer][middle_name]" class="form-control" maxlength="255" type="text" id="CustomerMiddleName"></div>
</div>
<div class="col-md-4">
<div class="form-group form-register required"><label for="CustomerSexe">Gender <span class="astrisk">*</span></label><select name="data[Customer][sexe]" class="form-control" id="CustomerSexe" required="required">
<option value="M">Male</option>
<option value="F">Female</option>
</select></div>
</div>
<div class="col-md-12 font-weight-bold">
<label for="CustomerBirthDateYear">Date Of Birth (yyyy/mm/dd)</label><span class="astrisk">*</span>
</div>
<div class="col-md-4">
<div class="form-group form-register"><label for="CustomerBirthDateYear">Year</label><select name="data[Customer][birth_date][year]" class="form-control" required="required" id="CustomerBirthDateYear">
<option value="">YYYY</option>
<option value="2024">2024</option>
<option value="2023">2023</option>
<option value="2022">2022</option>
<option value="2021">2021</option>
<option value="2020">2020</option>
<option value="2019">2019</option>
<option value="2018">2018</option>
<option value="2017">2017</option>
<option value="2016">2016</option>
<option value="2015">2015</option>
<option value="2014">2014</option>
<option value="2013">2013</option>
<option value="2012">2012</option>
<option value="2011">2011</option>
<option value="2010">2010</option>
<option value="2009">2009</option>
<option value="2008">2008</option>
<option value="2007">2007</option>
<option value="2006">2006</option>
<option value="2005">2005</option>
<option value="2004">2004</option>
<option value="2003">2003</option>
<option value="2002">2002</option>
<option value="2001">2001</option>
<option value="2000">2000</option>
<option value="1999">1999</option>
<option value="1998">1998</option>
<option value="1997">1997</option>
<option value="1996">1996</option>
<option value="1995">1995</option>
<option value="1994">1994</option>
<option value="1993">1993</option>
<option value="1992">1992</option>
<option value="1991">1991</option>
<option value="1990">1990</option>
<option value="1989">1989</option>
<option value="1988">1988</option>
<option value="1987">1987</option>
<option value="1986">1986</option>
<option value="1985">1985</option>
<option value="1984">1984</option>
<option value="1983">1983</option>
<option value="1982">1982</option>
<option value="1981">1981</option>
<option value="1980">1980</option>
<option value="1979">1979</option>
<option value="1978">1978</option>
<option value="1977">1977</option>
<option value="1976">1976</option>
<option value="1975">1975</option>
<option value="1974">1974</option>
<option value="1973">1973</option>
<option value="1972">1972</option>
<option value="1971">1971</option>
<option value="1970">1970</option>
<option value="1969">1969</option>
<option value="1968">1968</option>
<option value="1967">1967</option>
<option value="1966">1966</option>
<option value="1965">1965</option>
<option value="1964">1964</option>
<option value="1963">1963</option>
<option value="1962">1962</option>
<option value="1961">1961</option>
<option value="1960">1960</option>
<option value="1959">1959</option>
<option value="1958">1958</option>
<option value="1957">1957</option>
<option value="1956">1956</option>
<option value="1955">1955</option>
<option value="1954">1954</option>
<option value="1953">1953</option>
<option value="1952">1952</option>
<option value="1951">1951</option>
<option value="1950">1950</option>
<option value="1949">1949</option>
<option value="1948">1948</option>
<option value="1947">1947</option>
<option value="1946">1946</option>
<option value="1945">1945</option>
<option value="1944">1944</option>
<option value="1943">1943</option>
<option value="1942">1942</option>
<option value="1941">1941</option>
<option value="1940">1940</option>
<option value="1939">1939</option>
<option value="1938">1938</option>
<option value="1937">1937</option>
<option value="1936">1936</option>
<option value="1935">1935</option>
<option value="1934">1934</option>
<option value="1933">1933</option>
<option value="1932">1932</option>
<option value="1931">1931</option>
<option value="1930">1930</option>
<option value="1929">1929</option>
<option value="1928">1928</option>
<option value="1927">1927</option>
<option value="1926">1926</option>
<option value="1925">1925</option>
<option value="1924">1924</option>
<option value="1923">1923</option>
<option value="1922">1922</option>
<option value="1921">1921</option>
<option value="1920">1920</option>
<option value="1919">1919</option>
<option value="1918">1918</option>
<option value="1917">1917</option>
<option value="1916">1916</option>
<option value="1915">1915</option>
<option value="1914">1914</option>
<option value="1913">1913</option>
<option value="1912">1912</option>
<option value="1911">1911</option>
<option value="1910">1910</option>
<option value="1909">1909</option>
<option value="1908">1908</option>
<option value="1907">1907</option>
</select></div>
</div>
<div class="col-md-2">
<div class="form-group form-register"><label for="CustomerBirthDateMonth">Month</label><select name="data[Customer][birth_date][month]" class="form-control" required="required" id="CustomerBirthDateMonth">
<option value="">MM</option>
<option value="01">01</option>
<option value="02">02</option>
<option value="03">03</option>
<option value="04">04</option>
<option value="05">05</option>
<option value="06">06</option>
<option value="07">07</option>
<option value="08">08</option>
<option value="09">09</option>
<option value="10">10</option>
<option value="11">11</option>
<option value="12">12</option>
</select></div>
</div>
<div class="col-md-2">
<div class="form-group form-register"><label for="CustomerBirthDateDay">Day</label><select name="data[Customer][birth_date][day]" class="form-control" required="required" id="CustomerBirthDateDay">
<option value="">DD</option>
<option value="01">1</option>
<option value="02">2</option>
<option value="03">3</option>
<option value="04">4</option>
<option value="05">5</option>
<option value="06">6</option>
<option value="07">7</option>
<option value="08">8</option>
<option value="09">9</option>
<option value="10">10</option>
<option value="11">11</option>
<option value="12">12</option>
<option value="13">13</option>
<option value="14">14</option>
<option value="15">15</option>
<option value="16">16</option>
<option value="17">17</option>
<option value="18">18</option>
<option value="19">19</option>
<option value="20">20</option>
<option value="21">21</option>
<option value="22">22</option>
<option value="23">23</option>
<option value="24">24</option>
<option value="25">25</option>
<option value="26">26</option>
<option value="27">27</option>
<option value="28">28</option>
<option value="29">29</option>
<option value="30">30</option>
<option value="31">31</option>
</select></div>
</div>
<div class="col-md-12">
</div>
<div class="col-md-4">
<div class="form-group form-register required"><label for="CustomerBirthCity">Place of Birth (Name of the city)<span class="astrisk">*</span></label><input name="data[Customer][birth_city]" class="form-control" required="required" maxlength="255"
type="text" id="CustomerBirthCity"></div>
</div>
<div class="col-md-4">
<div class="form-group form-register required"><label for="CustomerBirthCountry">Country Of Birth <span class="astrisk">*</span></label><select name="data[Customer][birth_country]" class="form-control" required="required"
id="CustomerBirthCountry">
<option value="1">Afghanistan</option>
<option value="2">Albania</option>
<option value="3">Algeria</option>
<option value="4">American Samoa</option>
<option value="5">Andorra</option>
<option value="6">Angola</option>
<option value="7">Anguilla</option>
<option value="8">Antarctica</option>
<option value="9">Antigua And Barbuda</option>
<option value="10">Argentina</option>
<option value="11">Armenia</option>
<option value="12">Aruba</option>
<option value="13">Australia</option>
<option value="14">Austria</option>
<option value="15">Azerbaijan</option>
<option value="16">Bahamas</option>
<option value="17">Bahrain</option>
<option value="18">Bangladesh</option>
<option value="19">Barbados</option>
<option value="20">Belarus</option>
<option value="21">Belgium</option>
<option value="22">Belize</option>
<option value="23">Benin</option>
<option value="24">Bermuda</option>
<option value="25">Bhutan</option>
<option value="26">Bolivia</option>
<option value="27">Bosnia And Herzegovina</option>
<option value="28">Botswana</option>
<option value="29">Bouvet Island</option>
<option value="30">Brazil</option>
<option value="31">British Indian Ocean Territory</option>
<option value="32">Brunei Darussalam</option>
<option value="33">Bulgaria</option>
<option value="34">Burkina Faso</option>
<option value="35">Burundi</option>
<option value="36">Cambodia</option>
<option value="37">Cameroon</option>
<option value="38">Canada</option>
<option value="39">Cape Verde</option>
<option value="40">Cayman Islands</option>
<option value="41">Central African Republic</option>
<option value="42">Chad</option>
<option value="43">Chile</option>
<option value="44">China</option>
<option value="45">Christmas Island</option>
<option value="46">Cocos (keeling) Islands</option>
<option value="47">Colombia</option>
<option value="48">Comoros</option>
<option value="49">Congo</option>
<option value="50">Congo</option>
<option value="51">Cook Islands</option>
<option value="52">Costa Rica</option>
<option value="53">Cote D'ivoire</option>
<option value="54">Croatia</option>
<option value="55">Cuba</option>
<option value="56">Cyprus</option>
<option value="57">Czech Republic</option>
<option value="58">Denmark</option>
<option value="59">Djibouti</option>
<option value="60">Dominica</option>
<option value="61">Dominican Republic</option>
<option value="62">East Timor</option>
<option value="63">Ecuador</option>
<option value="64">Egypt</option>
<option value="65">El Salvador</option>
<option value="66">Equatorial Guinea</option>
<option value="67">Eritrea</option>
<option value="68">Estonia</option>
<option value="69">Ethiopia</option>
<option value="70">Falkland Islands (malvinas)</option>
<option value="71">Faroe Islands</option>
<option value="72">Fiji</option>
<option value="73">Finland</option>
<option value="74">France</option>
<option value="75">French Guiana</option>
<option value="76">French Polynesia</option>
<option value="77">French Southern Territories</option>
<option value="78">Gabon</option>
<option value="79">Gambia</option>
<option value="80">Georgia</option>
<option value="81">Germany</option>
<option value="82">Ghana</option>
<option value="83">Gibraltar</option>
<option value="84">Greece</option>
<option value="85">Greenland</option>
<option value="86">Grenada</option>
<option value="87">Guadeloupe</option>
<option value="88">Guam</option>
<option value="89">Guatemala</option>
<option value="90">Guinea</option>
<option value="91">Guinea-bissau</option>
<option value="92">Guyana</option>
<option value="93">Haiti</option>
<option value="94">Heard Island And Mcdonald Islands</option>
<option value="95">Holy See (vatican City State)</option>
<option value="96">Honduras</option>
<option value="97">Hong Kong</option>
<option value="98">Hungary</option>
<option value="99">Iceland</option>
<option value="100">India</option>
<option value="101">Indonesia</option>
<option value="102">Iran</option>
<option value="103">Iraq</option>
<option value="104">Ireland</option>
<option value="105">Israel</option>
<option value="106">Italy</option>
<option value="107">Jamaica</option>
<option value="108">Japan</option>
<option value="109">Jordan</option>
<option value="110">Kazakstan</option>
<option value="111">Kenya</option>
<option value="112">Kiribati</option>
<option value="113">North Korea</option>
<option value="114">South Korea</option>
<option value="115">Kosovo</option>
<option value="116">Kuwait</option>
<option value="117">Kyrgyzstan</option>
<option value="118">Lao People's Democratic Republic</option>
<option value="119">Latvia</option>
<option value="120">Lebanon</option>
<option value="121">Lesotho</option>
<option value="122">Liberia</option>
<option value="123">Libyan Arab Jamahiriya</option>
<option value="124">Liechtenstein</option>
<option value="125">Lithuania</option>
<option value="126">Luxembourg</option>
<option value="127">Macau</option>
<option value="128">Macedonia</option>
<option value="129">Madagascar</option>
<option value="130">Malawi</option>
<option value="131">Malaysia</option>
<option value="132">Maldives</option>
<option value="133">Mali</option>
<option value="134">Malta</option>
<option value="135">Marshall Islands</option>
<option value="136">Martinique</option>
<option value="137">Mauritania</option>
<option value="138">Mauritius</option>
<option value="139">Mayotte</option>
<option value="140">Mexico</option>
<option value="141">Micronesia</option>
<option value="142">Moldova</option>
<option value="143">Monaco</option>
<option value="144">Mongolia</option>
<option value="145">Montserrat</option>
<option value="146">Montenegro</option>
<option value="147">Morocco</option>
<option value="148">Mozambique</option>
<option value="149">Myanmar</option>
<option value="150">Namibia</option>
<option value="151">Nauru</option>
<option value="152">Nepal</option>
<option value="153">Netherlands</option>
<option value="154">Netherlands Antilles</option>
<option value="155">New Caledonia</option>
<option value="156">New Zealand</option>
<option value="157">Nicaragua</option>
<option value="158">Niger</option>
<option value="159">Nigeria</option>
<option value="160">Niue</option>
<option value="161">Norfolk Island</option>
<option value="162">Northern Mariana Islands</option>
<option value="163">Norway</option>
<option value="164">Oman</option>
<option value="165">Pakistan</option>
<option value="166">Palau</option>
<option value="167">Palestinian Territory</option>
<option value="168">Panama</option>
<option value="169">Papua New Guinea</option>
<option value="170">Paraguay</option>
<option value="171">Peru</option>
<option value="172">Philippines</option>
<option value="173">Pitcairn</option>
<option value="174">Poland</option>
<option value="175">Portugal</option>
<option value="176">Puerto Rico</option>
<option value="177">Qatar</option>
<option value="178">Reunion</option>
<option value="179">Romania</option>
<option value="180">Russian Federation</option>
<option value="181">Rwanda</option>
<option value="182">Saint Helena</option>
<option value="183">Saint Kitts And Nevis</option>
<option value="184">Saint Lucia</option>
<option value="185">Saint Pierre And Miquelon</option>
<option value="186">Saint Vincent And The Grenadines</option>
<option value="187">Samoa</option>
<option value="188">San Marino</option>
<option value="189">Sao Tome And Principe</option>
<option value="190">Saudi Arabia</option>
<option value="191">Senegal</option>
<option value="192">Serbia</option>
<option value="193">Seychelles</option>
<option value="194">Sierra Leone</option>
<option value="195">Singapore</option>
<option value="196">Slovakia</option>
<option value="197">Slovenia</option>
<option value="198">Solomon Islands</option>
<option value="199">Somalia</option>
<option value="200">South Africa</option>
<option value="201">South Georgia And The South Sandwich Islands</option>
<option value="202">Spain</option>
<option value="203">Sri Lanka</option>
<option value="204">Sudan</option>
<option value="205">Suriname</option>
<option value="206">Svalbard And Jan Mayen</option>
<option value="207">Swaziland</option>
<option value="208">Sweden</option>
<option value="209">Switzerland</option>
<option value="210">Syrian Arab Republic</option>
<option value="211">Taiwan</option>
<option value="212">Tajikistan</option>
<option value="213">Tanzania</option>
<option value="214">Thailand</option>
<option value="215">Togo</option>
<option value="216">Tokelau</option>
<option value="217">Tonga</option>
<option value="218">Trinidad And Tobago</option>
<option value="219">Tunisia</option>
<option value="220">Turkey</option>
<option value="221">Turkmenistan</option>
<option value="222">Turks And Caicos Islands</option>
<option value="223">Tuvalu</option>
<option value="224">Uganda</option>
<option value="225">Ukraine</option>
<option value="226">United Arab Emirates</option>
<option value="227">United Kingdom</option>
<option value="228" selected="selected">United States</option>
<option value="229">United States Minor Outlying Islands</option>
<option value="230">Uruguay</option>
<option value="231">Uzbekistan</option>
<option value="232">Vanuatu</option>
<option value="233">Venezuela</option>
<option value="234">Viet Nam</option>
<option value="235">Virgin Islands</option>
<option value="236">Virgin Islands</option>
<option value="237">Wallis And Futuna</option>
<option value="238">Western Sahara</option>
<option value="239">Yemen</option>
<option value="240">Zambia</option>
<option value="241">Zimbabwe</option>
</select></div>
</div>
<div class="col-md-4 hide-state-birth0" style="display: none;">
<div class="form-group form-register"><label for="CustomerBirthStateCa">Province Of Birth<span class="astrisk">*</span></label><select name="data[Customer][birth_state_ca]" class="form-control" id="CustomerBirthStateCa">
<option value="">Select</option>
<option value="1">Alberta</option>
<option value="2">British Columbia</option>
<option value="3">Labrador</option>
<option value="4">Manitoba</option>
<option value="5">New Brunswick</option>
<option value="6">Newfoundland</option>
<option value="7">Nova Scotia</option>
<option value="8">Nunavut</option>
<option value="9">North West Terr.</option>
<option value="10">Ontario</option>
<option value="11">Prince Edward Is.</option>
<option value="12">Quebec</option>
<option value="13">Saskatchewen</option>
<option value="14">Yukon</option>
</select></div>
</div>
<div class="col-md-4 hide-state-birth1">
<div class="form-group form-register"><label for="CustomerBirthState">State Of Birth<span class="astrisk">*</span></label><select name="data[Customer][birth_state]" class="form-control" id="CustomerBirthState" required="required">
<option value="">Select</option>
<option value="2">Alabama</option>
<option value="3">Alaska</option>
<option value="4">Arizona</option>
<option value="5">Arkansas</option>
<option value="6">California</option>
<option value="7">Colorado</option>
<option value="8">Connecticut</option>
<option value="9">Delaware</option>
<option value="10">District of Columbia</option>
<option value="11">Florida</option>
<option value="12">Georgia</option>
<option value="13">Hawaii</option>
<option value="14">Idaho</option>
<option value="15">Illinois</option>
<option value="16">Indiana</option>
<option value="17">Iowa</option>
<option value="18">Kansas</option>
<option value="19">Kentucky</option>
<option value="20">Louisiana</option>
<option value="21">Maine</option>
<option value="22">Maryland</option>
<option value="23">Massachusetts</option>
<option value="24">Michigan</option>
<option value="25">Minnesota</option>
<option value="26">Mississippi</option>
<option value="27">Missouri</option>
<option value="28">Montana</option>
<option value="29">Nebraska</option>
<option value="30">Nevada</option>
<option value="31">New Hampshire</option>
<option value="32">New Jersey</option>
<option value="33">New Mexico</option>
<option value="34">New York</option>
<option value="35">North Carolina</option>
<option value="36">North Dakota</option>
<option value="37">Ohio</option>
<option value="38">Oklahoma</option>
<option value="39">Oregon</option>
<option value="40">Pennsylvania</option>
<option value="41">Rhode Island</option>
<option value="42">South Carolina</option>
<option value="43">South Dakota</option>
<option value="44">Tennessee</option>
<option value="45">Texas</option>
<option value="46">Utah</option>
<option value="47">Vermont</option>
<option value="48">Virginia</option>
<option value="49">Washington</option>
<option value="50">West Virginia</option>
<option value="51">Wisconsin</option>
<option value="52">Wyoming</option>
</select></div>
</div>
<div class="col-md-4 hide-state-birth2" style="display: none;">
<div class="form-group form-register"><label for="CustomerBirthState2">State Of Birth</label><input name="data[Customer][birth_state2]" class="form-control" value="" type="text" id="CustomerBirthState2"></div>
</div>
<div class="col-md-4">
<div class="form-group form-register required"><label for="CustomerEmploymentStatus">Employment Status <span class="astrisk">*</span></label><select name="data[Customer][employment_status]" class="form-control" id="CustomerEmploymentStatus"
required="required">
<option value="">Select</option>
<option value="1">Employed</option>
<option value="2">Self-employed</option>
<option value="3">Retired</option>
<option value="4">Unemployed</option>
<option value="5">Student</option>
<option value="6">Child</option>
</select></div>
</div>
<div class="col-md-4">
<div class="form-group form-register required"><label for="AdressAdress">Your Current Address <span class="astrisk">*</span></label><input name="data[Adress][adress]" class="form-control" required="required" maxlength="512" type="text"
id="AdressAdress"></div>
</div>
<div class="col-md-4">
<div class="form-group form-register"><label for="AdressAdress2">Address line 2</label><input name="data[Adress][adress2]" class="form-control" maxlength="512" type="text" id="AdressAdress2"></div>
</div>
<div class="col-md-4">
<div class="form-group form-register required"><label for="AdressTown">City <span class="astrisk">*</span></label><input name="data[Adress][town]" class="form-control" required="required" maxlength="255" type="text" id="AdressTown"></div>
</div>
<div class="col-md-4">
<div class="form-group form-register required"><label for="AdressState">State <span class="astrisk">*</span></label><select name="data[Adress][state]" class="form-control" required="required" id="AdressState">
<option value="">Select</option>
<option value="2">Alabama</option>
<option value="3">Alaska</option>
<option value="4">Arizona</option>
<option value="5">Arkansas</option>
<option value="6">California</option>
<option value="7">Colorado</option>
<option value="8">Connecticut</option>
<option value="9">Delaware</option>
<option value="10">District of Columbia</option>
<option value="11">Florida</option>
<option value="12">Georgia</option>
<option value="13">Hawaii</option>
<option value="14">Idaho</option>
<option value="15">Illinois</option>
<option value="16">Indiana</option>
<option value="17">Iowa</option>
<option value="18">Kansas</option>
<option value="19">Kentucky</option>
<option value="20">Louisiana</option>
<option value="21">Maine</option>
<option value="22">Maryland</option>
<option value="23">Massachusetts</option>
<option value="24">Michigan</option>
<option value="25">Minnesota</option>
<option value="26">Mississippi</option>
<option value="27">Missouri</option>
<option value="28">Montana</option>
<option value="29">Nebraska</option>
<option value="30">Nevada</option>
<option value="31">New Hampshire</option>
<option value="32">New Jersey</option>
<option value="33">New Mexico</option>
<option value="34">New York</option>
<option value="35">North Carolina</option>
<option value="36">North Dakota</option>
<option value="37">Ohio</option>
<option value="38">Oklahoma</option>
<option value="39">Oregon</option>
<option value="40">Pennsylvania</option>
<option value="41">Rhode Island</option>
<option value="42">South Carolina</option>
<option value="43">South Dakota</option>
<option value="44">Tennessee</option>
<option value="45">Texas</option>
<option value="46">Utah</option>
<option value="47">Vermont</option>
<option value="48">Virginia</option>
<option value="49">Washington</option>
<option value="50">West Virginia</option>
<option value="51">Wisconsin</option>
<option value="52">Wyoming</option>
</select></div>
</div>
<div class="col-md-4">
<div class="form-group form-register required"><label for="AdressPostalCode">ZIP Code <span class="astrisk">*</span></label><input name="data[Adress][postal_code]" class="form-control" required="required" maxlength="45" type="text"
id="AdressPostalCode"></div>
</div>
<div class="col-md-4">
<div class="form-group form-register required"><label for="CustomerEmail">Email Address<span class="astrisk">*</span></label><input name="data[Customer][email]" class="form-control required" maxlength="255" type="email" id="CustomerEmail"
required="required"></div>
</div>
<div class="col-md-4">
<div class="form-group form-register required"><label for="CustomerEmailConfirm">Confirm Email<span class="astrisk">*</span></label><input name="data[Customer][email_confirm]" class="form-control required" autocomplete="off" type="email"
id="CustomerEmailConfirm" required="required"></div>
</div>
<div class="col-md-4">
<div class="form-group form-register"><label for="CustomerPhone">Phone Number<span class="astrisk">*</span></label><input name="data[Customer][phone]" class="form-control required" placeholder="(207) 123-5461" required="required" maxlength="45"
type="tel" id="CustomerPhone"></div>
</div>
<div class="col-md-12 text-center">
<input type="submit" id="regSub" class="btn ETP-button" value="Submit »">
</div>
</form>Text Content
* Home * About * FAQ * Contact PRE-QUALIFICATION TO APPLY FOR APEC CARD Please fill out form below to check if you are eligible to Apply for APEC CARD Warning: Failure to correctly answer these verification questions may result in the delay or denial of your application. Have you ever been convicted of a criminal offense in the United States or any other country? Yes No Have you ever received a waiver of inadmissibility to the U.S. from a U.S. government agency? Yes No Have you ever been found in violation of customs laws? Yes No Have you ever been found in violation of immigration laws? Yes No Submit Please proceed with the Pre-Application below. 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Ontario Prince Edward Is. Quebec Saskatchewen Yukon State Of Birth* Select Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming State Of Birth Employment Status * Select Employed Self-employed Retired Unemployed Student Child Your Current Address * Address line 2 City * State * Select Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming ZIP Code * Email Address* Confirm Email* Phone Number* © 2020 All rights reserved * Refund Policy * Privacy Policy