TEXAS TOWER PASSPORT and VISA SERVICES

Specializing in Rush Passports, Visas for all Countries, Certified Birth Certificates

2020 Montrose Blvd. Suite 400 Phone: (713) 874 - 1420

Houston, Texas 77006 Fax : (713) 874 - 1245

Website:www.texastower.net E-mail info@intldriverlicense.net

After you have printed and filled out the application, please print and then fill out this order form. Then send both forms, along with two passport-style photos (with your signature on the back of each photo) and a copy (front and back) of your United States Driver’s License.

Applicant’s Name: _________________________________________________

Return Address:___________________________________________________

________________________________________________________________

Email Address: ____________________________________________________

Phone: (daytime)_____________________ (evening)______________________

*Have FedEx deliver *Departure date or date by which

Without a signature? you need the license: _____________

(please circle)

YES NO

PROCESSING OPTIONS: (please circle) RUSH REGULAR

Time for regular processing is 4-5 days from the day we receive your request.

First license: $71.00
Additional licenses: $54.00

Time for rush processing is 2 days from the day we receive your request.

First license: $91.00
Additional licenses: $74.00

*For delivery in the U.S., we accept the following forms of payment:
checks, money orders, cashiers checks, Visa, Mastercard, American Express and Discover

Credit card number:_________________________ Expiration Date:_______________

***V-Code on Visa or Mastercard:___________________

(this is the last 3 numbers in the signature box on the back of your card…applies to Visa and Mastercard ONLY

Orders shipped internationally must be paid for with a credit card.

Revised 2/7/04