Just-In Document Service, Inc.

5 West Main Street, Suite 201

Elmsford, NY 10523

Phone: (914) 592 - 2760     Fax: (914) 592 - 2987

Info@justindocument.com

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PASSPORT & VISA REQUEST FORM / CREDIT CARD AUTHORIZATION INFORMATION

From:

Company Name

Address

City / State / Zip
Phone Fax
Contact Name    
Last Name         
First Name         
Middle Name      
E-mail Address   
Date of Birth      
Passport Number
Expiration Date   
Nationality          
Departure Date From US
Passport Service (Please check one) :
2- 3days $155.00 4 - 6 days $120.00 7 - 10 days $75.00
for passport same day service please contact us
1st Time Renewal Add Pages Amendment

Visa Service: NO RUSH varies by country $ 60.00

Rush (Please check one):

  
2 - 3 Days $ 105.00 4 days or more $85

DATE NEEDED IN YOUR OFFICE:

Ship To (Check if Same):
Name

Company Name

Address

City / State / Zip

Phone Mail Code
Form Of Payment (please check)
Pre-approved billing or Company Checkmoney orderDiner's
American ExpressMasterCardVisa Discover
Card Number Expiration Date

Name (as it appears on card)

Billing Address of Cardholder

I hereby authorize just-In Document Service, Inc. to charge all fees and service for myself, and for other persons I designate.
 
_________________________________________
Signature of Cardholder
 Country NamePurpose of TripEntries#Entry DateExit Date
1.
2.
3.
Return Via (Please Check one):
Federal ExpressAirborne UPS DHL Office Pickup$5 UPS/DHL account label
Just-In Documents will gladly return your documents via the carrier of your choice. If you like to use Airborne, UPS, or DHL you MUST provide COMPLETED airbill (excluding Just-In Documents in the form filed). If you have an account number with Federal Express either provide a label or indicate the account number below. Unless otherwise indicated on this form Just-In Document Service will return your documents via Federal Express and charge you accordingly. Please include label for UPS/DHL account a $5.00 label fee if not included with request.
Overnight Mail Account Number
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Just-In Document Service, Inc. assumes information given is accurate at time of release. We do not assume responsibility for changes or incorrect information given by government agencies. We do not assume responsibility for any loss or damage done to passport while in the hands of overnight carries, delivery services, US Department of State, embassies or consulates. Upon completion of this application all above information is fully acknowledged and agreed by the customer and Just-In Document Service, Inc.