DMS Order Form

Order Form

1775 Eye Street N.W.
Suite 1150
Washington, DC 20006

Date of Departure

Passport Requested by (Date):

Service Requested: (Please check all services you would like below)

Visa Service

Passport

Personal Information:

First Name

Last Name

Date of Birth

Address

Home Phone

Work Phone

Mobile Phone

Email Address

Shipping Information: (If different from above)

Company Name

Address

Additional Information

If you have additional applicants that need our visa or passport services, please fill out the additional information below.

Additional Travelers

Payment Information:

Expiration Date

Credit Card Verification Number

Billing Information:

Address

Authorization:

Please note that there is an additional 3.5% processing fee.

By signing below, you are acknowledging and agreeing to pay DMS Visa International for its services.

Signature

PLEASE PRINT AND MAIL THE COMPLETED ORDER FORM TO:

1775 Eye Street N.W. Suite 1150 Washington, DC 20006

DMS Visa International | (202) 745-3815 | dmsvisainternational.com