I _______________________________________ authorize Capital Visa Services 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:_____________________________
Date of Birth:________/________/________
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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.