HOME ABOUT US CONTACT US POLICIES PASSPORT NEWS F.A.Q. TESTIMONIALS

CHINA VISA SERVICE IN THE U.S.


China Visa Inc. Customer Information Form (Affiliated with Deluxe Passport Express)


Visa Application Information

Name
Date of Birth
Home Phone
Cell Phone
Work Phone
Email Address

Please send visa to


Name
Company (optional)
Address
Address continued
City
State, Zip

Travel Info


What is your departure date?
When do you need your visa?

Return shipping of visa

Overnight delivery (add $25)
Please use my enclosed company FedEx airbill or my FedEx acct.#
Check here if you want your visa delivered without a signature

Payment information

Payment included (check one)
Check(s) or money order(s) included
Please charge fee(s) to my credit card

Consular fee$
Deluxe fee$
Shipping$
Total $=

If paying by credit card


Card Number
Expiration date
Security Code
Name on Card
Total Charge
Billing address and Zip Code
Cardholder signature

X___________________________________________
I authorize Deluxe Passport Express to charge my card for the above amount.

  Print Before submitting print and sign