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LEGALIZATIONS
  
  1. Complete all the fields with the needed information.
  2. Review the screen for accuracy.
  3. Print the completed form by clicking on the print button at the bottom of the form.
  4. Review the printed copy to ensure the correct information.
  5. Return it to TRAVISA with all required documents.
U.S. Departure Date:
Date of Birth:
Customer Information:
Name:
Alternate Contact:
Company:
Address:
City:
State:
Zip:
Telephone:
 ( ) -

Fax:

( ) -
Email:
Shipping Information:
Same as previous:
Name:
Company:
Address:
City:
State:
Zip:
Telephone:
 ( ) -
Fax:
 ( ) -
SHIPPING OPTIONS:
Passenger Information:
  Passenger's Name: Passport #: Date Needed:
1.
2.
Additional Comments and Information:
Fees and Payment:
State Department Fee***

Service Fee State Department

Services Fee

$25.00

Leather Passport Cover

$9.95

Shipping (selected
from above):

TOTAL DUE:
Payment:
CCN:
Exp. Date:

I authorize Travisa to charge the
TOTAL AMOUNT DUE to my credit card:

__________________________________________________
(signature)
Payment Options:
  • Requirements and fees are subject to change without prior notice. All fees are non-refundable.
  • Requirements and fees are for U.S. Citizens only. Contact Travisa for information on other nationals.
  • All Travisa fees are payable in cash, money order or company check. Visa, Mastercard, and American Express are also accepted.

  • * Allow up to 2 weeks for delivery
    ** Weekday, continental US only
    *** Includes $5 Check-writing fee

 


TRAVISA acts only as an agent, and accepts no responsibility for the services of any Travel Agent, Consulate, Passport Agency or Embassy in connection with the granting of visas, nor for any delays, loss of passports occasioned by such services or the U.S. Mail. Damage compensation is not available.