EFTA00314148.pdf

Send to: G3 Global Services m Attn: Passport Department 388 Market Street, Suite 1520 San Francisco, CA 94111 877.898.1203 I SECOND VALID PASSPORT SAN FRANCISCO Your invoice win be sent to your contact email. • Check here if you require a hard Copy included with your return delivery. RIN009SV Payment Information hits azrahir to 0 Payment Via Check - StisiSenite$ [x Payment Via Credit Card: C :314," visa,mastercam, 54 7 a 1 S 1 3. 7 3 0 8 - 9 2 6 :X1Conclerge Service Requested Exp. Date: 11 / 19 Security Code: 3 5 7 OR _ American Express: Total Fees from Applicable Fees Page Exp Date / _ Security Code: Name as it appears on the card: FEE # Travelers TOTAL Darren K. Indyke Concierge Fee $175.00 X US Government Fee 3170.00 X $170.00 Billing Address 575 Lexington Ave, 4th Floor G3 Service Fee 5275.00 X $275.00 City. NY Slate NY1Zip:i 10022 Passport Ihotecbcv Plan $40.00 X $40.00 Return 06-very Fee S5.00 Signature: Subtotal 5665.00 Add S% for credit card convenience tee $37.20 LiPayment Via Approved Billing Terms G3 Customer Number. Billing, P.D.. Project or Reference Code:- Total Payment Enclosed 5702.29 7 Traveler Information sasanis S30 Traveler 1 Name- Jeffrey Edward Epstein Date of Birth: Oil /20/1953 Traveler 2 fikime- Date of Rirth Passport Service Service: xl Second Valid Passport (Book Only) Second Valid Passport (Book and C.vdj PIazt;:,/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 COMM: Darren K. Indyke. PLLC Contact Email (required): Daytime Phone: Maxie Phone Return Delivery Address Name' Darren K. Indyke C4("Pany. Darren K. Indyke, PLLC Street Address: 575 Lexington, 4th Floor " if New York State: NY Zip Cod 0022 Daytime Tune: Mobile Phone EFTA00314148