Form V.2011a - Visa Application Form Of The People'S Republic Of China Page 4
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11Send to: G3 Visas & Passports
Attn: Visa Department
NEW YORK
60 East 42nd Street, 4th Floor, Suite 457
CHINA
- FLIGHT CREW
New York, NY 10165
888.448.4727 |
Your invoice will be sent to your contact email.
Check here if you require a hard copy included with your return delivery.
Traveler Names
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Visa Service
Visa Type:
Tourist
Business
Processing Speed:
Mission Critical
Priority
Expedited
Flight Crew
Other__________
Travel Details
Date of US Departure:
I must have my passport no later than:
Other visa or passport services requested:
Notes:
Contact Information
Who should G3 contact about this request?
Name:
Company:
Contact Email (required):
Daytime Phone:
Mobile Phone:
G3 Customer Number:
N/A
Return Delivery Address
This must be a physical address for FedEx delivery; no P.O. Boxes.
Name:
Company:
Street Address:
City:
State:
Zip Code:
Daytime Phone:
Mobile Phone:
Payment Information
Total Fees from Applicable Fees Page
Credit Card
Check
Approved Billing Terms
FEE
# Travelers
TOTAL
Billing, P.O., Project or Reference Code#
Consular Fee
X
=
For Payment Via Credit Card:
G3 Service Fee
X
=
CLS/ITAS Fee
-
-
-
X
=
Visa/MasterCard:
Return Delivery Fee
Exp. Date: ____ / ____ Security Code:
Subtotal
Add 5% for credit card convenience fee
OR
-
-
American Express:
Total Payment Enclosed
Exp. Date: ____ / ____ Security Code:
Name as it appears on the card:
Billing Address:
City:
State
Zip:
Signature: _________________________________________
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