1. Chinese Name - Skip here if you do not have a Chinese name
2. Former Name - Skip here if you had no other name than present name
3. Surname and Given Name - Fill in here your Last Name and First Name
4. Sex, Male/Female - Fill in the correct box
5. Date of Birth - Fill in your birth date
6. Place of Birth - Fill in your birth place
7. Nationality - If you are U.S. citizen, fill in U.S.A.  If not, fill in the country name on your passport.
8. Former Nationality - If you were from another country, fill in the name in here.
9. Occupation - Job, or retired.
10. Office Phone No. - Fill in your work phone number, or whichever phone number that you can be contacted.
11. Full name and address of your company/employer - Fill in related information
12. Home Address - Fill in your home address
13. Home Phone number - your home phone number
14. Passport Type - If you are a regular traveler, check the box [ Ordinary ] -  Passport Number - Valid until (the date) shown on your passport - Issued by (your company issuing agency)
15. Purpose of Journey in China - Visit China
16. Places to visit in China - Fill in the names of the cities you are planning to visit.
17. Name, address, phone number of inviting organization in China - Fill in here Regent China Tours Tel: 1800-896-1916 if you are traveling with Regent.
18. Number of Entries - Fill in [ Single ]
19. Date of Each Entry - Fill in date that you expect to arrive in China
20. Duration of Stay in China - Fill in the length of time you plan in China.
21. Requested Days of Processing - Fill in [ 72 hours rush ], or [ mail service ]
22. Have you applied for a Chinese visa before - Fill in your answer here
23. Have you ever been declined for your Chinese visa application - Fill in your answer here
24. Accompanying persons included in passports - If your passport has more than one name on it, fill the other names here if that person is traveling with you.
25. Date & Signature

When you send in your passport to Regent for processing, don't forget to enclose a passport size photo along with your completed visa application form.