Guatemala Interview 1Información del Aplicante2Lugar de Entrega3Ubicación de la Entrevista4Información sobre tarifas de visa5Revisar6Pago Important Notice Important Information The information you enter for your appointment request must match the information on your DS-160. Please make sure the following details match your DS-160: First Name Last Name Passport Number Date of Birth Visa Class Nationality Country of Birth Upload Your DS-160 Confirmation Page*Accepted file types: pdf, Max. file size: 300 MB. This field is hidden when viewing the formFecha DD slash MM slash YYYY Nombre*Su nombre debe coincidir con su pasaporte y DS-160. Nombre Apellido País / Autoridad que expidió el Pasaporte*Please SelectAfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongoCongo, The Democratic Republic Of TheCook IslandsCosta RicaCroatiaCubaCyprusCzech RepublicCôte D'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFalkland Islands (Malvinas)Faroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly See (Vatican City State)HondurasHong KongHungaryIcelandIndiaIndonesiaIran, Islamic Republic OfIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic OfKorea, Republic ofKosovoKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyan Arab JamahiriyaLiechtensteinLithuaniaLuxembourgMacaoMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesia, Federated States OfMoldova, Republic ofMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalThe NetherlandsNetherlands AntillesNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorthern Mariana IslandsNorwayOmanPakistanPalauPalestinian AuthorityPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint HelenaSaint Kitts And NevisSaint LuciaSaint MartinSaint Pierre And MiquelonSaint Vincent And The GrenedinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard And Jan MayenSwazilandSwedenSwitzerlandSyrian Arab RepublicTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited States Minor Outlying IslandsUruguayUzbekistanVanuatuVenezuela, Bolivarian Republic ofViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland IslandsPaís de Nacimiento*Please SelectAfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongoCongo, The Democratic Republic Of TheCook IslandsCosta RicaCroatiaCubaCyprusCzech RepublicCôte D'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFalkland Islands (Malvinas)Faroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly See (Vatican City State)HondurasHong KongHungaryIcelandIndiaIndonesiaIran, Islamic Republic OfIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic OfKorea, Republic ofKosovoKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyan Arab JamahiriyaLiechtensteinLithuaniaLuxembourgMacaoMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesia, Federated States OfMoldova, Republic ofMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalThe NetherlandsNetherlands AntillesNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorthern Mariana IslandsNorwayOmanPakistanPalauPalestinian AuthorityPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint HelenaSaint Kitts And NevisSaint LuciaSaint MartinSaint Pierre And MiquelonSaint Vincent And The GrenedinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard And Jan MayenSwazilandSwedenSwitzerlandSyrian Arab RepublicTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited States Minor Outlying IslandsUruguayUzbekistanVanuatuVenezuela, Bolivarian Republic ofViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland IslandsPaís de Residencia Permanente*Please SelectAfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongoCongo, The Democratic Republic Of TheCook IslandsCosta RicaCroatiaCubaCyprusCzech RepublicCôte D'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFalkland Islands (Malvinas)Faroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly See (Vatican City State)HondurasHong KongHungaryIcelandIndiaIndonesiaIran, Islamic Republic OfIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic OfKorea, Republic ofKosovoKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyan Arab JamahiriyaLiechtensteinLithuaniaLuxembourgMacaoMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesia, Federated States OfMoldova, Republic ofMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalThe NetherlandsNetherlands AntillesNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorthern Mariana IslandsNorwayOmanPakistanPalauPalestinian AuthorityPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint HelenaSaint Kitts And NevisSaint LuciaSaint MartinSaint Pierre And MiquelonSaint Vincent And The GrenedinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard And Jan MayenSwazilandSwedenSwitzerlandSyrian Arab RepublicTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited States Minor Outlying IslandsUruguayUzbekistanVanuatuVenezuela, Bolivarian Republic ofViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland IslandsNúmero de pasaporte*Número DS-160*Ingrese su número de código de barras DS-160 único. Se encuentra en la parte superior derecha de la página de confirmación de su DS-160 y comienza con AA-. Por favor distinga entre los dos, como el número cero (0) y uno (1), y la letras O y I. Tipo de Visa*Please SelectB1 Business / Conference / Domestic EmployeeB1/B2 Business & Tourism (Temporary visitor)B2 Tourism / Medical TreatmentC1 TransitC1/D Crewmember in transitD1 CrewmemberE1 Treaty Trader / Child of an E1 / Spouse of an E1E2 Treaty Investor / Child of E2 / Spouse of an E2E3 Australian Spec. WorkerE3D Spouse or Child of an E3F1 StudentF2 Spouse or Child of an F1F3 Commuter StudentH1B Speciality OccupationH1B1 Chilean or Singaporean Spec. OccupationH1C Nurse in shortage areaH2A Agricultural WorkerH2B Nonagricultural WorkerH3 TraineeH4 Spouse / Child of H1BH4 Spouse / Child of H1B1H4 Spouse / Child of H1CH4 Spouse / Child of H2AH4 Spouse / Child of H2BH4 Spouse / Child of H3I Foreign Media Representative / Spouse or Child of an IJ1 Professional Exchange Visitor (e.g., physician, scholar)J1 Work Exchange Visitor (e.g., teacher, intern, summer work)J2 Spouse or Child of a J1 - Professional Exchange VisitorJ2 Spouse or Child of a J1 - Work Exchange VisitorL1 Intra-company TransfereeL2 Spouse or Child of an L1M1 StudentM2 Spouse or Child of an M1M3 Commuter StudentO1 Extraordinary AbilityO2 Alien Accompanying/AssistingO3 Spouse or Child of an O1 or O2P1 Internationally Recognized AlienP2 Artist/Entertainer Exchange ProgramP3 Artist / Entertainer in Cultural ProgramP4 Spouse or Child of a P1, P2, or P3Q1 Cultural Exhange VisitorR1 Religious WorkerR2 Spouse or Child of an R1T1 Victim of TraffickingT2 Spouse of a T1T3 Child of a T1T4 Parent of a T1T5/T6 Sibling of a T1 / Derivative Beneficiary of a T1TD Spouse or Child of a TNTN NAFTA ProfessionalU1 Victim of CrimeU2 Spouse of a U1U3 Child of a U1U4 Parent of a U1U5 Sibling of a U1Número de petición*Por lo general, comienza con tres letras EAC, WAC, LIN o SRC, seguidas de 10 dígitos numéricos. Fecha de nacimiento*DayDay12345678910111213141516171819202122232425262728293031MonthMonth123456789101112YearYear20502049204820472046204520442043204220412040203920382037203620352034203320322031203020292028202720262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Sexo* Masculino Femenino Teléfono principal*Dirección de correo electrónico* Ingrese correo electrónico Confirmar correo electrónico Le fue previamente expedida una visa para entrar a los Estados Unidos?* Sí No Nombre del Consulado donde se emitió la Visa*Please SelectGuatemalaIssuing Post Not ListedTipo de visa anterior*Please SelectB1 Business / Conference / Domestic EmployeeB1/B2 Business & Tourism (Temporary visitor)B2 Tourism / Medical TreatmentC1 TransitC1/D Crewmember in transitD1 CrewmemberE1 Treaty Trader / Child of an E1 / Spouse of an E1E2 Treaty Investor / Child of E2 / Spouse of an E2E3 Australian Spec. WorkerE3D Spouse or Child of an E3F1 StudentF2 Spouse or Child of an F1F3 Commuter StudentH1B Speciality OccupationH1B1 Chilean or Singaporean Spec. OccupationH1C Nurse in shortage areaH2A Agricultural WorkerH2B Nonagricultural WorkerH3 TraineeH4 Spouse / Child of H1BH4 Spouse / Child of H1B1H4 Spouse / Child of H1CH4 Spouse / Child of H2AH4 Spouse / Child of H2BH4 Spouse / Child of H3I Foreign Media Representative / Spouse or Child of an IJ1 Professional Exchange Visitor (e.g., physician, scholar)J1 Work Exchange Visitor (e.g., teacher, intern, summer work)J2 Spouse or Child of a J1 - Professional Exchange VisitorJ2 Spouse or Child of a J1 - Work Exchange VisitorL1 Intra-company TransfereeL2 Spouse or Child of an L1M1 StudentM2 Spouse or Child of an M1M3 Commuter StudentO1 Extraordinary AbilityO2 Alien Accompanying/AssistingO3 Spouse or Child of an O1 or O2P1 Internationally Recognized AlienP2 Artist/Entertainer Exchange ProgramP3 Artist / Entertainer in Cultural ProgramP4 Spouse or Child of a P1, P2, or P3Q1 Cultural Exhange VisitorR1 Religious WorkerR2 Spouse or Child of an R1T1 Victim of TraffickingT2 Spouse of a T1T3 Child of a T1T4 Parent of a T1T5/T6 Sibling of a T1 / Derivative Beneficiary of a T1TD Spouse or Child of a TNTN NAFTA ProfessionalU1 Victim of CrimeU2 Spouse of a U1U3 Child of a U1U4 Parent of a U1U5 Sibling of a U1Fecha de emisión de la Visa*DayDay12345678910111213141516171819202122232425262728293031MonthMonth123456789101112YearYear20502049204820472046204520442043204220412040203920382037203620352034203320322031203020292028202720262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Fecha de vencimiento de la Visa*DayDay12345678910111213141516171819202122232425262728293031MonthMonth123456789101112YearYear20502049204820472046204520442043204220412040203920382037203620352034203320322031203020292028202720262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920¿Viaja desde otro país para solicitar una visa de Estados Unidos en Guatemala?* Sí No Marque todas las condiciones que apliquen* I am physically present in the country where I am applying and am a citizen or legal resident of that country (or hold a valid residence permit). My previous U.S. visa was issued when I was 18 years of age or older. I am applying for the same visa type as my previous visa. I am renewing a full-validity, multiple-entry visa (e.g., 10-year visitor visa, where applicable). My previous visa is still in my possession and was not lost, stolen, or revoked. My previous visa does not contain any annotations such as “Clearance Received” or “212(a) Waiver of Ineligibility.” My previous visa and current passport contain the same name, date of birth, place of birth, and nationality (or I have official documentation of any legal name change). I answered “No” to all Medical, Criminal, Security, and Immigration Violation questions on the DS-160 form. I have not been refused a U.S. visa recently (or if I was refused, I was later issued a visa in the same category). I have an urgent need to travel to the United States within the next few weeks (medical emergency, serious illness, death in the family, or urgent business travel). None of the above apply. Su tasa de visa incluye la devolución de sus documentos a una sucursal del servicio de correo. Se puede solicitar la entrega a una dirección personal o comercial por un cargo adicional. Tendrá la opción de actualizar la entrega al final del proceso de programación. Seleccione un centro del servicio de mensajería para la devolución de sus documentos.Agencia de Retiro de Documentos (sin costo adicional)*DHL Express Zona 4 - Via 7 04-20 Zona 4, Guatemala, 1004Nombre de la persona autorizada para retirar sus documentos* Nombre Apellido Puedes consultar el tiempo medio de espera para una cita aquí. Tenga en cuenta que es posible que haya citas más tempranas disponibles para emergencias. Si la fecha que recibe no se ajusta a sus planes de viaje, envíenos un correo electrónico y le solicitaremos una cita acelerada. Recibirá una confirmación oficial de la fecha y hora de su entrevista por correo electrónico.Ubicación de la entrevista*Please SelectGuatemalaFecha de la Entrevista* DD slash MM slash YYYY Fecha de la Entrevista* DD slash MM slash YYYY Detalles de la tarifa de MRV Las tarifas se asignarán al solicitante {applicant_name (First):15.3} {applicant_name (Last):15.6} nacido el {applicant_birth_day:21}, momento en el cual la información del solicitante no puede modificarse. Las tarifas no son reembolsables ni transferibles (ya sea a otra persona o para su uso en otro país). Puede actualizar su dirección de correo electrónico y número de teléfono en cualquier momento. Puede cambiar su número de pasaporte solo una (1) vez después de que se haya realizado un pago. NO puede cambiar el nombre de pila, el apellido, el país que emitió el pasaporte, el país de nacimiento, la fecha de nacimiento o el género asociado a su perfil de solicitante después de pagar su tarifa de visa. Las tarifas de visa son las siguientes: 1. Tarifa de reserva: USD$165 por solicitante - Cubre el procesamiento en los registros de la Embajada de los EE. UU. 2. Tarifas de MRV: USD$185 para visas (B1/B2)(J),(F),(M),(I), (C1/D). USD$205 para visas (H), (L), (O), (P), (Q) o (R). USD$315 para todas las visas de no inmigrante (E-1) y (E-2) de categoría E. Todos los solicitantes de visa, incluidos los niños, deben pagar una tarifa de solicitud de visa de no inmigrante (MRV) no reembolsable ni transferible. Se requiere el pago de la tarifa de solicitud de Visa, ya sea que una solicitud resulte o no en la emisión de una Visa de EE. UU. Términos de servicio*La información proporcionada es correcta y verdadera a lo mejor de mi conocimiento He leído y acepto el Descargo de responsabilidad, los Términos y condiciones y la Política de no devolución y entiendo que se trata de un procesamiento de terceros. Si el solicitante intenta informar falsamente que una transacción fue fraudulenta y solicita un reembolso de su tarifa, la Embajada de EE. UU. sera notificada. Esto puede resultar en la cancelación de su cita programada. Estoy de acuerdo con los términos de servicio Por Favor Confirme el Tipo de Visa*B1 Business/ConferenceB1/B2 Business & TourismB2 Tourism/Medical TreatmentC1 TransitC1/D Crewmember in TransitD1 CrewmemberE1 Treaty TraderE2 Treaty InvestorE3 Australian Spec. WorkerE3D Spouse or Child of an F1F1 StudentF2 Spouse or child of an F1F3 commuter StudentH1B Speciality occupationH1B1 Chilean or Singaporean Spec. OccupationH1C Nurse in shortage areaH2A agricultural WorkerH3 TraineeH4 Spouse/Child of H1BH4 Spouse/Child of H1B1H4 Spouse/Child of H1CH4 Spouse/Child of H2AH4 Spouse/Child of H2BH4 Spouse/Child of H3I Foreign Media RepresentativeJ1 Exchange VisitorJ2 Spouse or Child of a J1L1 Intra-Company transfereeL2 Spouse Or Child of an L1M1 StudentM2 Spouse or Child of an M1M3 Commuter StudentO1 Extraordinary AbilityO2 Alien Accompanying/AssistingO3 Spouse or Child of an O1 or O2P1 Internationally recognized AlienP2 Artist/Entertainer Exchange ProgramP3 Artist/entertainer in Cultural ProgramP4 Spouse or Child of a P1, P2, or P3Q1 Cultural Exchange VisitorR1 Religious WorkerR2 Spouse/Child of an R1T1 Victim of traffickingT2 Spouse of a T1T3 Child of a T1T4 Parent of a T1T5 Sibling of a T1TD Spouse or Child of a TNTN NAFTA ProfessionalU1 Victim of CrimeU2 Spouse of a U1U3 Child of a U1U4 Parent of a U1U5 Sibling of a U1 Por favor confirme que toda la información esta correcta. {all_fields} Total $0.00 E-Signature of Applicant Nombre Apellido Por favor escriba el nombre del solicitante Dirección de la Tarjeta de Crédito* Dirección Dirección Línea 2 Ciudad Estado / Provincia Código postal / ZIP AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands País Tarjeta de Crédito* American ExpressDiscoverMasterCardVisaSupported Credit Cards: American Express, Discover, MasterCard, Visa Número de tarjeta Month010203040506070809101112 Year20262027202820292030203120322033203420352036203720382039204020412042204320442045 Fecha de vencimiento Código de seguridad / CVV Nombre del titular de la tarjeta Número de teléfono del titular de la tarjeta*Número de teléfono de la persona que paga la cita. Dirección de correo electrónico del titular de la tarjeta* Enter Email Confirm Email Dirección de correo electrónico de la persona que paga la cita.E-Signature of Cardholder* Nombre Apellido Firma de la persona que paga la cita.Consent and Authorization*Certifico, bajo pena de perjurio conforme a las leyes de los Estados Unidos de América, que lo anterior es verdadero y correcto. Reconozco y acepto que ingresar mi nombre en el campo de firma reemplaza legalmente mi firma física. Entiendo que, al otorgar esta autorización, doy mi consentimiento para que UVA gestione estos procesos en mi nombre, y confirmo que soy plenamente responsable de cualquier cargo incurrido como parte de este servicio. Reconozco que UVA no está afiliada al gobierno de los Estados Unidos. Por la presente, autorizo a UVA a actuar en mi nombre para programar citas y pagar la tarifa MRV no reembolsable para los fines de esta transacción. I Consent and Authorize this transaction.