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Adult
Letter of Authorization
Attention
U.S. Passport Services,
I,
__________________________________, authorize Jerry Eisom, Charseita Reed are To process my U.S. application and to retrieve my new
Passport and send it to me, Along with any other documents that I sent to acquire a new passport.
_________________________
________________________ ____________
Applicant's
Signature
Social Security Number
Date of Birth
_______________
________________________
_____________________
Date
Work/Daytime Telephone
Home Telephone
Passport to be
shipped to:
| NAME(or
care of): |
_________________________________________________________________ |
| COMPANY: |
_________________________________________________________________ |
| ADDRESS: |
_________________________________________________________________ |
| CITY,STATE,ZIP |
_________________________________________________________________ |
| TELEPHONE: |
_________________________________________________________________ |
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FED-EX ALL DOCUMENTS
TO THIS ADDRESS:
OVERNIGHT PASSPORT COURIER
ATTN: JERRY EISOM
187 DARTMOUTH STREET
BOSTON, MA 02116
Please call with your FED-EX air bill tracking numbers.
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