U.S. Department of State

Passport Agency

I, _________________________________ hereby give my authorization to Passport and Visa Specialists and it's agents to act on my behalf regarding the processing of my passport. I have given my consent allowing Passport and Visa Specialists to submit and collect my completed passport as well as permission to discuss my application with a Passport Office Agent should it be deemed necessary.

My date of birth is:______________________

I will be departing the United States on _______________________.

I am requesting that my application be expedited, as I am required to obtain a visa(s) to enter _________________________.

_____________________________________
Original signature of applicant

_____________________________________
Parents signature if applicant is under 16 yrs. Old

PLEASE NOTE: WE MUST HAVE AN EXTRA COPY OF THIS LETTER AND A COPY OF YOUR PROOF OF DEPARTURE ON THE OUTSIDE OF YOUR SEALED ENVELOPE

Note to Applicant
1. This letter must bear the true and correct signature of the applicant.
2. A husband may not sign on behalf of his wife, or vise versa.
3. In the event that it becomes necessary this letter also authorizes "Passport Services" to mail
passport back to our company 'US Vital Documents'.
4. US Vital Documents is not responsible for delays in processing due to incomplete applications, missing or incorrect proof of US Citizenship, proof of identity, proof of travel, missing photographs, incorrect passport execution fees. I understand that delays in processing may occur due to the volume and workload at the passport agency and they are not the responsibility