Send to: G3 Global Services Attn: Passport Department SAN FRANCISCO 388 Market Street, Suite 1520 San Franersco, CA 34 SECOND VALID PASSPORT 3/7.898.1203 | SanFranciscoe@qgSvisus.com Your invoice will be sent to your contact email, MJ Check here if you require a hard copy included with your retum delivery. Payment Information | |Payment Via Check #: y! i Payment Via Creciit Card: [ », ierae Service Ri ms Visa/MasterCard: 5474-15 13-7308.9256 x Concierge Service Requested Exp. Date:_'' /_19 Security Code: 3 5 7 American Express: I = P cogs Total Fees from Applicable Fees Page Date:____./ ___ Security —_—, ai ig ae: FEE = # Travelers TOTAL Darren K. indyke Concierge Fee $175.00 X $175.00 ; US Government Fee $170.00 X $170.00 Billing Address: 575 Lexington Ave, 4th Floor G3 Service Fee $275.00 X $275,00 City; NY State NY Zip: 10022 Passport Protection Plan $40.00 X $40.00 Return Delivery Fee $84.00 Signature: $744.00 Add 5% for credit card convenience fee $37.20 Payment Via Approved Billing Terms G3 Customer Number, Billing, P.0., Project or Reference Code#: Total Payment Encloved |$781.20 Traveler information Date of Birth: 01/20/1953 Date of Birth: Travel Details | must have my passport no later than: 96/27/2016 Contact Information Name: Darren Indyke ona Daytime Phone a” Return Delivery Address Name: Jeffrey Epstein Sweet Address: 9 East 71st Street CY: New York Daytime Phone: 2127509895 GES 7/05 - PML REV EFTA00314133