I _______________________________________ Date of Birth:________/________/________

authorize American Passport Express to process my application for US Passport, to pickup my completed

passport and to discuss all matters with the Department of State pertaining to the processing of my

passport application and issuance of my passport.

 

 

Signed:_____________________________

Today's Date:________/________/________

 

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Headquarters address: 170 Commerce Way, Portsmouth NH 03801*
*Note: Many of our applications are NOT shipped to this address. Please call 800-455-5166 to verify your shipping address.
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American Passport Express LLC. acts only as an agent on behalf of the applicant. Please Refer to our "Legal Terms" which appear on our website www.americanpassport.com and which are incorporated by reference.