Send to: G3 Global Services pita ciel yet anna SAN FRANCISCO SECOND VALID PASSPORT ‘Your invoice will be sent to your contact email. MB Check here i you require a hard copy included with your retum delivery Payment Information | |Payment Via Check 2: ix! Payment Via Credit Card 54.74.15 13.7308-9256 |x, Concierge Service Requested Exp. Date:_'' /_19 Security Code: 3 5 7 American Express: a Exp. Date:___/ __ Security Code: Name as it appears on the card: a ca — “a Concierge Fee $175.00 X $175.00 Y : US Government Fee $170.00 X $170.00 Billing Address: 575 Lexington Ave, 4th Floor G3 Service Fee $275.00 X $275.00 Cty: NY State NY Zip; 10022 Passport Protection Plan $40.00 X = $40.00 Return Delivery Fee $5.00 Subtotal $665.00 Signature Add 5% for credit card convenience fee $37.20 S from Apphcable Fees Page Payment Via Approved Billing Terms G3 Customer Number, Billing, P.0., Project or Reterence Codes: Total Payment Enclosed $702.20 Traveler information Traveler 1 Name: Jeffrey Edward Epstein Date of Birth: 94/20/1953 Traveler 2 Name: Date of Birth: Passport Service nierere @ockend Cond Processing Speed: | Mission Critical Priority | Expedited Travel Details Date of US Departure: ANTICIPATED 06/_/2016 — !musthavemy passportno later than: 6) /2016 Other visa or passport services requested: Notes: Contact Information Name: Darren K. Indyke Company: Darren K. Indyke, PLLC Daytime Phone: Return Delivery Adcress Name: Darren K. Indyke Street Address: 575 Lexington, 4th Floor GY New York EFTA00314142