EFTA00314148.pdf

m Send to: G3 Global Services Attn: Passport Department 388 Market Street, Suite 1520 San Francisco, CA 94111 877.898.1203 I SAN FRANCISCO SECOND VALID PASSPORT Your invoice win be sent to your contact email. • Check here if you require a hard Copy included with your return delivery. Payment Via Check Payment Information hits azrahir to - StisiSenite$ [x Payment Via Credit Card: visa,mastercam, 54 7 a 1 S 1 3 . 7 3 0 8 - 9 2 6 Exp. Date: 11 / 19 Security Code: 3 5 7 OR _ American Express: Exp Date / _ Security Code: Name as it appears on the card: Darren K. Indyke Billing Address 575 Lexington Ave, 4th Floor City. NY Slate NY1Zip:i 10022 Signature: Li Payment Via Approved Billing Terms G3 Customer Number. Billing, P.D.. Project or Reference Code:- :X1Conclerge Service Requested Total Fees from Applicable Fees Page FEE # Travelers Concierge Fee $175.00 X TOTAL US Government Fee 3170.00 X $170.00 G3 Service Fee 5275.00 X $275.00 Passport Ihotecbcv Plan $40.00 X $40.00 Return 06-very Fee S5.00 Subtotal 5665.00 Add S% for credit card convenience tee $37.20 Total Payment Enclosed 5702.29 7 Traveler Information Traveler 1 Name- Jeffrey Edward Epstein Traveler 2 fikime- Date of Birth: Oil /20/1953 Date of Rirth Passport Service Service: xl Second Valid Passport (Book Only) Second Valid Passport (Book and C.vdj PI azt;:,/nty Speed: x) Mission Critical i —Prionty lExpechted Travel Details Date of US Departure ANTICIPATED 06/ /2016 I must have my passport no later than: /_2016 Other visa or passport services requested: Notes: Contact Information Name: Darren K. Indyke Contact Email (required): Daytime Phone: COMM: Darren K. Indyke. PLLC Maxie Phone Return Delivery Address Name' Darren K. Indyke Street Address: 575 Lexington, 4th Floor " if New York Daytime Tune: C4("Pany. Darren K. Indyke, PLLC State: NY Mobile Phone Zip Cod 0022 :314," RIN009SV sasanis S30 0 C EFTA00314148