US Passport Visa
2600 S. Gessner, Suite 330 Houston, Texas 77063
Specializing in Rush Passports, Visas for all Countries, and Certified Birth Certificates
Phone: 713-629-8330 Fax: (713) 629-0396 
http://www.us-passport-visa.com email: info@us-passport-visa.com
INSTRUCTIONS FOR SAME / NEXT DAY SERVICE OF PASSPORTS
Once you have all of your information together you need to
Federal Express Priority Overnight it to the following address:
FEDERAL EXPRESS HOLD LOCATION:
TANYA KHOMENKO / PVE
200 W. Jackson Street
Chicago, IL 60606
Phone: 713-629-8330
 NOTE: Please fill out the following information
and fax this sheet to (713) 629-0396
Also Send a copy with your passport information.

Name of Applicants:_____________________________________________


Maiden Name:___________________________________________________

Address to Return Passports:		 Address for Saturday Delivery: ( if needed )

___________________________ ______________________________

___________________________
______________________________

Phone Numbers:______________________________Date of Birth:__________________

E Mail_________________________

Date of Departure:___________________Date your package will arrive in our office:____________________________

Have Fed Ex Deliver without a signature? ( circle ) Yes No
Service Fees
Passport & Visa Specialists Fee
$ 149.00
Government Fee
$ 60.00
Return Delivery Fee
$ 17 / $ 27
Total $___________
US Government Fees
(per person)		 Circle One
New / Lost Passport
(in sealed envelope)		 $115.00
Renewal $115.00
Extra Pages $60.00
Name Change $60.00
Credit Card Number:

______________________________
V- Code ( Required)
US Passport Visa
The Passport And Visa Specialists Fees
Passport $149.00
Expires:_________________________
Signature_________________________
Return Delivery Fee:
Federal Express Weekday: $17.00
Federal Express Saturday $27.00
Airport to Airport $150.00
We only accept credit cards for Same / Next Day Passports.
By Faxing this form to US Passport Visa - The Passport & Visa Specialists, I understand there is a $25.00 cancellation fee for each passport.
*PVS stands for Passport and Visa Specialists' processing fees. US Passport Visa, Passport and Visa Specialists or any of its agents our not responsible for mistakes or delays from passport offices, consulates, embassies travel agents, overnight courier services, or vital records departments. I understand that the passport office or above agencies can delay or deny passports, visas or birth certificates at their own discretion.