"Request Form for Passport/Visa Processing - a-1 Passport & Visa Express" - Washington, D.C.

ADVERTISEMENT
ADVERTISEMENT

Download "Request Form for Passport/Visa Processing - a-1 Passport & Visa Express" - Washington, D.C.

Download PDF

Fill PDF online

Rate (4.7 / 5) 19 votes
A-1 Passport & Visa Express
samcarlo@msn.com
1411 K Street NW. Suite 805 Washington, DC. 20005~Tel: (202) 639-1500~Fax: (202) 639-9596~E-mail:
Request form for passport/visa processing
This form is for A-1 Passport & Visa Express and must be fully completed and included with every request for passport/visa
processing. The purpose of this form is to clearly identify what type of processing is needed, date of immediate travel out of
the U.S. and where to ship your documents to. THIS IS AN ORDER FORM NOT PASSPORT/VISA APPLICATION.
Today’s Date:
Service requested by :(Name)___________________________________________________________________
(Email)__________________________________________ (Phone)_____________________________________
Your Company’s: (Name) _____________________________________________________________________
(Address) ___________________________________________________________________________________
Project Number: _____________________________________________________________________________
FULL NAME OF APPLICANT(S):
____________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
PASSPORT PROCESSING: (If you have a passport and only need visas, please skip this section)
(Please circle one)
nd
[New/First Time U.S. Passport] – [Renewal of U.S. Passport] – [Add Passport Pages] – [2
. Passport]
[Passport amendment]
VISA PROCESSING: (List the countries you require a visa and number of entries required)
1)_____________________Single – double - Multiple 3)______________________Single – Double – Multiple
2)_____________________Single – double - Multiple 4)______________________Single – Double - Multiple
IMMEDIATE DEPARTURE DATE FROM THE U.S.A – (VERY IMPORTANT):_____________________
APPLICANT’S EMAIL ADDRESS:_____________________________________________________________
DAY TIME TELEPHONE NUMBER :(_____)____________________ CELL( ____)____________________
SHIPPING ADDRESS TO RETURN YOUR PASSPORT/VISA: (We only ship via Fed Ex)
Name
____________________________________________
Company
____________________________________________
Address
____________________________________________
City, Sate, Zip
____________________________________________
TYPE OF PAYMENT:
(CHECKS SHOULD BE MADE PAYABLE TO: A-1 PASSPORT & VISA EXPRESS)
FOR PAYMENT BY CREDIT CARD PLEASE COMPLETE AUTHORIZATION ON THE NEXT PAGE
A-1 Passport & Visa Express
samcarlo@msn.com
1411 K Street NW. Suite 805 Washington, DC. 20005~Tel: (202) 639-1500~Fax: (202) 639-9596~E-mail:
Request form for passport/visa processing
This form is for A-1 Passport & Visa Express and must be fully completed and included with every request for passport/visa
processing. The purpose of this form is to clearly identify what type of processing is needed, date of immediate travel out of
the U.S. and where to ship your documents to. THIS IS AN ORDER FORM NOT PASSPORT/VISA APPLICATION.
Today’s Date:
Service requested by :(Name)___________________________________________________________________
(Email)__________________________________________ (Phone)_____________________________________
Your Company’s: (Name) _____________________________________________________________________
(Address) ___________________________________________________________________________________
Project Number: _____________________________________________________________________________
FULL NAME OF APPLICANT(S):
____________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
PASSPORT PROCESSING: (If you have a passport and only need visas, please skip this section)
(Please circle one)
nd
[New/First Time U.S. Passport] – [Renewal of U.S. Passport] – [Add Passport Pages] – [2
. Passport]
[Passport amendment]
VISA PROCESSING: (List the countries you require a visa and number of entries required)
1)_____________________Single – double - Multiple 3)______________________Single – Double – Multiple
2)_____________________Single – double - Multiple 4)______________________Single – Double - Multiple
IMMEDIATE DEPARTURE DATE FROM THE U.S.A – (VERY IMPORTANT):_____________________
APPLICANT’S EMAIL ADDRESS:_____________________________________________________________
DAY TIME TELEPHONE NUMBER :(_____)____________________ CELL( ____)____________________
SHIPPING ADDRESS TO RETURN YOUR PASSPORT/VISA: (We only ship via Fed Ex)
Name
____________________________________________
Company
____________________________________________
Address
____________________________________________
City, Sate, Zip
____________________________________________
TYPE OF PAYMENT:
(CHECKS SHOULD BE MADE PAYABLE TO: A-1 PASSPORT & VISA EXPRESS)
FOR PAYMENT BY CREDIT CARD PLEASE COMPLETE AUTHORIZATION ON THE NEXT PAGE
CREDIT CARD AUTHORIZATION FORM
I,___________________________________________________, (print full name) Authorize A-1 Passport & visa Express to
charge $__________ (Please leave blank if you are not yet sure what the total would be, otherwise print amount in words):
____________________________________________________________________________________________________
to the credit card of my choice as indicated below (check one)
[ ] Visa
[ ] MasterCard
[ ] American Express
[ ] Discover
Credit Card Number _______________________________________________3/4 digits Security number_______________
Expiration date: Month____________________Year_____________________
Credit card billing address including zip code________________________________________________________________
________________________________________________________________
Three digit credit card code number at the back of your credit card___________
Company credit card code number if any_______________________________
Billing Telephone #________________________________________________
Day time Telephone #______________________________________________
Signature:________________________________________________________
Date signed:______________________________________________________
SHIPPING INSTRUCTION:
Please note that it is always best to send your document to the following Fed Ex hold location address using only
Fed Ex Priority overnight service:
Attention: Sam Carlo
A-1 Passport & Visa
Express 1411 K Street NW.
Suite 805
Washington, DC. 20005
(202) 639-1500
Sending your documents via Fed Ex will speed up the processing of your paperwork.
IT IS ALWAYS BEST CALL OUR OFFICE PRIOR TO SEINDING YOUR DOCUMENTS.
Page of 2