Statement of Non-Liability: Ambassador Passport and Visa Services, Inc. is not responsible for mistakes, delays, or decisions by the U.S. Government, passport
offices, consulates, embassies, travel agencies, courier services, foreign governments, various records departments, as well as uncontrollable events such as force
majeure and acts of God. I understand that the passport office or visa office or any of the above agencies can delay or deny passports, visas or birth certificates.
Ambassador Passport and Visa Services, Inc. will not be held liable for any financial loss occurred by delay in the process. Regardless of the result, Ambassador
Passport and Visa Services can collect its fees, once the service has been conducted. By submitting this application, you agree to these terms.
This form is to advise Ambassador Passport and Visa Services of the type of service you are requesting, the departure date of your trip, and the return address for
mailing the completed documents. In order to properly process your requested service, please include this form with your Passport / Visa application request.
Full Name of Applicant
Name of Company
Telephone
Address
BRITISH PASSPORT SERVICES REQUESTED
Processing Time
Regular
Rush
VISA PROCESSING
Will Call
Overnight
FedEx FedEx FedEx
2nd Day Air
Saturday Delivery
Other
(Skip if requesting a Passport Only)
Name of Country
Name of Country
Name of Country
Single Entry Double Entry Mutiple Entry Other
Single Entry
Single Entry
Double Entry
Double Entry
Mutiple Entry
Mutiple Entry
Other
Other
Processing Time
Regular
Rush
Express
Ultra Rush
TRAVEL DATE
PAYMENT METHOD
Cardholder’s Name
Card Number
Expiration Date
Billing Address
CVC Code
I hereby authorize Ambassador Passport and Visa Services to charge the cost of services rendered to the above credit card.
RETURN METHOD
Full Name
Address
Telephone
Company Name (Optional)
City
E-Mail Address
State ZIP
COVER LETTER
Ambassador Passport and Visa Services, Inc.,
2811 Wilshire Blvd., Suite 720, Santa Monica, CA 90403
Tel: (310) 828-7878 • Fax: (310) 828-7474
AmbassadorPassportandVisa.com
info@ambpv.com
CheckAmEx VISA MasterCard Money Order
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