EFTA00314137.pdf

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