EFTA00314133.pdf

Send to: G3 Global Services Attn: Passport Department 388 Market Street. Slide ispo SAN FRANCISCO Pon Francisco. CA 941/1 8/.896.1203 I Sard-rancirmotr.v.Ivems coil, SECOND VALID PASSPORT Your invoice vNl be sent to your contact email. • Check here tt you require a hard copy included with your return delivery. Payment Information X Go: E.,ervictl, '.crit noted yea/Mastercard: 5 4 7 4 . 1 S 1 3 - 7 3 0 8 - 9 2 5 6 Sa. Date: " 19 Security Code: 3 5 7 on American Express: Exp. Date: / Security Code: Name as it appears on the card: FEE a Travelers TOTAL Darren K. Indyke Concierge Fee SI'S.® X = $175.00 US Government Fee 5170.00 X = $170.00 Bing Address: 575 Lexington Ave. 4th Floor G3 Service Fee 5275.00 X = $275.00 ger NY Slate NY Zip: 10022 PassponPracction Flan $40.00 x 540.00 Return Delivery Fee $84.00 Signathre: Subtotal $744.00 Add 5% for credit card convenience fee $37.20 P.-0/711i(:11- 7 - G3 Wanner Humber, Bang, P.O., flora or Retaonce Coon: Total Payment Enclosed 5781.20 Traveler Infornlittinr1 Traveler 1 Name: Jeffrey Epstein Date of 01/20/1953 Trader 2 Name: Date ot BirM: Passport Service Service: x Second Valid Passport (Book Orin ' Processing Speed: c Mission Critical Priority &pelted Second Void Passport (Book and Card) Travel Details Date of US DeDadore: I mast have my passport no later that 06127/2016 Other visa or passport services requested: Notes: Contact Information Name: Darren Indyke Company: Contact EmS (required) Daytime Phone Mobie Phone: Return Delivery Address Name: Jeffrey Epstein COMPerly: Street Address 9 East 71st Street ate: New York State: NY Zap Cade 10021 LIMMIL2 Daytime Phone: 2127509895 Mobile Phone: EFTA00314133