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 email@example.com
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: _________________________________________________
Email Address: ____________________________________________________
Phone: (daytime)_____________________ (evening)______________________
*Have FedEx deliver *Departure date or date by which
Without a signature? you need the license: _____________
PROCESSING OPTIONS: (please circle) RUSH REGULAR
Time for regular processing is 4-5 days from the day we receive your request.
First license: $95.00
Additional licenses: $70.00
Time for rush processing is 2 days from the day we receive your request.
First license: $135.00
Additional licenses: $100.00
*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
Your Signature: ________________________________________________
Date Signed : ________________________________
Orders shipped internationally must be paid for with a credit card.