EFTA00314137.pdf

CSI Send to: G3 Global Sur vices Attn: Passport Department 388 Motet Street. Suite 1020 Sari Framer:co. CA 94111 81 /.89S.1203 1 Stullrarrcr:GO‘scjaystrat;.COn SAN FRANCISCO SECOND VALID PASSPORT Vow inioce vodl be sent to your contact email. ■ Cheek here n you reqtare a bard copy MCIU0ed with your return delivery. P.iyitir 9 it Information vsaimastercasd. 5 4 7 .1. 15 13.7 3 0 8.9 2 5 G Exp. Date: II OR American Express: 19 Securey Code: 3 5 7 Thep. Date: _ I Security Code: Mine as it appears on the card: Darren K. Indyke Billing Address: 575 Lexington Ave. rith Floor city: NV State NY Zip 10022 Signalum: Ca CuelOrner Number. Billing. P.D.. Project or Reference C u: olo x ,r ' Vice' f;rett;cr.lr..cl FEE r Travelers TOTAL Concierge Fee $175.00 X = 5175.00 US Government Fee 5170 00 X - 5170.03 G3 Service Fee $275.00 X = $275.00 Passport Protection Plan 540.00 X - $40.00 Return Dehvery Fee $84.00 Subtotal $744.00 Add 5%10i credit card convenience fee $37.20 Total Payment Enclosed $781.20 Traveler 1 Name: Jeffrey Epstein Daimler 2 Name: Traveler Informatory Date of Boot 01/29/1953 Date of Birth: Passport Service Soviet x Second Valid Passport (Book Only) Second Valid Pe-sport (Book and Card) Processing Speed: x Mission Critical Priority Expedited . Ayr, : Dr trti:-. Date of US Departure: ANTICIPATED 06/_72016 Other visa or passport services requested: NOteS: I mitt have my bassoon no later than: 06/ /2016 Contact Information Nome Darren Indyke Contact Email (required): Daytime Phone: la Return Delivery Address Name: Darren Indyke Companr Darren K. Indyke, PLLC Street Address: 575 Lexington. 4th Floor City: New York State: NY Imp C°de: 70022 Daytime Phone: RON Phone: Canna or. MoD le Fitone :41 EFTA00314137