Letter of Authorization

                         U.S. Department of State Philadelphia Office


                          Date _______________________

                    I ______________________________________ authorize Speedy Passport & Visa
                   
                    to submit my passport application to a U.S. Passport Agency and accept the delivery

                    on my behalf.

                     Please choose one of the following:

                    ____ I authorize Speedy Passport & Visa to discuss any problems that which may arise
                    with my passport application.

                    ____ I want the U.S. Passport Agency to contact me directly should a  problem arise
                    with my passport application.

                    ____________________________ Applicants name:


                    ____________________________  Date of Birth:


                    ____________________________  Departure Date


                    ____________________________   Destination


                    ____________________________  Applicants Signature _________________  Date


                    ____________________________  Parents signature     __________________ Date                                                                                                (if applicant is under 16)

                    ____________________________  Contact number
                      
                             1-888-389-2210 OR 215-389-2210