LEGALIZATIONS ORDER FORM

Visa Obtainers, Inc.
1010 Vermont Ave. N.W. Shite 617
Washington, DC 20005
(202) 347-2909

Company Information:
Company Name: ______________________________________________________________________
   
Requested by: ____________________________  Phone # : ________________________________
 
Address: ____________________________________________________________________________
   
City: _____________________________ State: ______________ Zip: _________________
Service Requested: (e.g. Secretary of State)

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Payment:

1. If you are paying by check or money order: check or Money Order to Visa Obtainers, Inc. in the amount of: $ ___________

2. If you are paying by credit card: I, herby authorize Visa Obtainers, Inc. to charge all fees associated with this request to the following credit card:

[  ] American Express                 [  ] Master Card                         [  ] Visa

Card Number: ______________________________________________ Exp: ____________________

Signature: __________________________________________________________________________

Visa Obtainers, Inc. acts only as an agent on behalf of the applicant and accepts no responsibility for the services of the Consulate, Embassy, chambers, secretary of state or the US state department regarding the granting of documents legalizations nor for any delay, loss of materials or documents occasioned by such services or by any delivery services. Damage compensation not available from Visa Obtainers, Inc.
FOR OFFICE USE ONLY:

Received on: ______________ Via: ____________ Payment Received: _________________________

Returned Shipping On: ______________Via: ____________ Airbill: ____________________________

Comments: _________________________________________________________________________