I am a client of VisaRite Services Inc. I hereby authorize VisaRite to charge payment for following service to my credit card:
   Visa Service
   Passport Service
   Other Services

Card Number:
Expiration date:	/
Card Holder Name:
Card CVC (What's this?)
Amount Authorized:
Billing Address:
City:		State:	Zip:
Tel:
Date:
Signature:			<<< -- Sign Here
By sign this form, you indicate you have read and agree with the terms & conditions set forth by VisaRite.