EFTA00314156.pdf

Send to: G3 Global Services Attn: Passport Department 388 Market Street, Suite 1520 Snn Francisco CA corm 877.898.1203 SAN FRANCISCO SECOND VALID PASSPORT four invoice will to sent to your contact email. • (beck here it you require a hard copy included with your return deirtery. Payment Information 1: Payment Via Check #: [xjPayment Via Credit Card: Visa/MasterCard. Conciorgo Service Roc_ Neste . , Exp. Date. 11 / 19 Security l" 3 7 „ OR American Express: Exp / Security Code: Name as it appears nn the card: Darren K. Indyke Billug Address: 575 Lexington Ave. 4th Floor City. NY State NT Zto. 10022 Signature: Li Payment Via Approved Billing Terms G3 Customer Number. Billing, P.O.. Pierce( or Reference Codek. Total Fees from Applicable Fees Page FEE *Travelers TOTAL Concierge Fee $175.00 X $175.00 US Government Fee $170.00 X = $170.00 63 Service Fee 5275.00 X = $275.00 Paswcrt Protector Plan $40.00 X Return Delivery Fee S5 s4.00 °° Subtotal 5885.00 Add 5% for credit card convenience fee 537.20 Total Payment Enclosed 5702.20 Traveler Information Trawler 1 Name: Jeffrey Edward Epstein Dale of Birth- 01/20/1953 Traveler 2 Name: Date of Say Passport Service Service: :X i Second Valid Passport (Book Only) Processing Speed: x Mission Critical Enonty Excediten Second Valid Passport (Book and Card) Travel Details Date of US Departure. ANTICIPATED 06/20/2016 I must have my passport no later than: 06/06/2016 Other visa or passport services requested: Wes. Contact Information Nate: Darren K. Indyke Contact Email (required): Daytime Phone C4rnpany: Darren K. Indyke. PLLC Mobile Phone: Return Delivery Address Name: Darren K Indyke Street Address- 575 Lexington, 4th Floor City New York State: NY Daytime Ptone White Phone. Company Darren K Indyke. PLLC 7'1) Code 10022 rn 03 p n EFTA00314156