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PASSPORT & VISA SPECIALISTS

Specializing in Rush Passports, Visas for all Countries, Certified Birth Certificates and Passport Photos
2600 S. Gessner Rd. Suite 200
Houston, Texas 77063
Phone (713) 629-8330
Fax (713) 785-1461
​http://www.quickpassport.com
email: info@quickpassport.com

Letter of Authorization

Please carefully read the information below before completing this Letter of Authorization.

An Individual's personal information cannot be released by the U.S. government to another party without the written consent of the individual under the provisions of the Privacy Act of 1974 (5 USC 552a). As a result, an employee at a U.S. passport agency cannot discuss the details of your passport application with a third party without your written consent.

Please check all that apply:

Applicant Information
(Note: All of the information below may ONLY be filled out by the applicant, parent, legal guardian, or person legally acting in loco parentis)
Applicant Name:  
  (Last Name, First Name, Middle Name)
Applicant Phone No:     Date:  
  (Area Code-XXX-XXXX)     (MM/DD/YYYY)
Courier Company Name:  
Applicant Signature:  
(If the applicant is under the age of 16 the parent(s), legal guardian(s), or person legally acting in loco parentis must sign)