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Travel Document Systems, Inc.

CREDIT CARD AUTHORIZATION FORM

I, ____________________________________________________________________
(Please Print Name)

Authorize Travel Document Systems, Inc. to charge my PASSPORT and / or VISA Fees to my American Express, Visa, Mastercard or Discover Credit Card

Credit Card Number:__________________________________________________________

Expiration Date:______________________

Authorized Name on Credit Card:_____________________________________________

Amount Authorized: US$_________________________________________________

Signature:___________________________________________________________________________

Please sign and return to Travel Document Systems, Inc. office.

New York Office - 641 Lexington Avenue, Suite 1435 New York NY 10022

Washington D.C. Office - 925 Fifteenth Street NW Suite 300, Washington, D.C. 20005

San Francisco Office - 3 Embarcadero Center, Lobby Level Suite 2, San Francisco CA 94111