Date:
To: Passport Services-US
Department of State
50 West Washington Street
Norwalk, CT
I authorize Just-In Document Service, Inc./New England Visa Service
representatives (914-592-2760) to submit and pick-up my passport for
renewal, 1st time or any amendments indicated on forms enclosed. They
have my full permission to handle all my passport needs and answer
any questions that will help expedite this request.
NAME PRINTED:
Signature: _________________________________
Please note I am in need of a visa or visas for the country or countries
listed on my flight itinerary, and must obtain this visa in a expedited
fashion to meet my departure date indicated. (Please check mark
if applicable).
Date of Birth:
Departure Date from the USA: