Reverse side of United States Customs and Border Protection Form 6059B, Arrival Card.
United States Customs and Border Protection
Derived from PDF: <a rel="nofollow" class="external free" href="https://www.cbp.gov/sites/default/files/documents/CBP%20Form%206059B%20English%20%28Sample%20Watermark%29.pdf">https://www.cbp.gov/sites/default/files/documents/CBP%20Form%206059B%20English%20%28Sample%20Watermark%29.pdf</a>