Tel: (646) 397-8728 Fax: (888) 781-8298
Email: service@visarite.com Web: www.visarite.com
|
||
| 325 W 38th Street, Suite 1105, New York, NY 10018, USA Tel: (646) 397-8728 Fax: (888) 781-8298 Email: service@visarite.com Web: www.visarite.com |
||
| NAME: | ||||||||||||||
(
First Middle Last) |
||||||||||||||
| DATE OF BIRTH: | ||||||||||||||
(Month
/ Day / Year) |
||||||||||||||
| CONTACT PHONE : | ||||||||||||||
| I authorize VisaRite Services Inc. to submit my passport application to US Passport Agency and to collect it when issued on my behalf. | ||||||||||||||
| I authorize the US Passport Agency to discuss any problems which may arise with my passport application with VisaRite Services Inc. | ||||||||||||||
|
||||||||||||||