TDS

TRAVEL DOCUMENT SYSTEMS, INC.

To: U.S. Department of State
      Passport Agency

I,________________________________________________________________
            (full name and birth date)
hereby authorize TRAVEL DOCUMENT SYSTEMS to pick up my passport and to discuss the status of my application with the Passport Services Staff.

My departure date from the United States is ______________________.

________________________________________
Signature of Applicant
(It is illegal for any person other than the applicant to sign this passport document. Original signature is required)

________________________________________
Signature of parent if applicant is under age 18

Complete if Applicable:
I am requesting that my application for passport be expedited, as I will also be required to apply for visas for the following country/ies:_____________________________________________.

A copy of my itinerary or air tickets are enclosed as confirmation of urgent departure.

Travel Document Systems - 925 Fifteenth Street N.W. 3rd Floor - Washington, D.C. 20005

San Francisco Office - Three Embarcadero Center - Lobby Level - San Francisco, CA 94111

New York Office - 641 Lexington Ave #1435 - New York, NY 10022