Epstein Secrets

account balance using a credit card this month, or to change your billing address. Name (as ;1 appears on the carte Type of card (cneck one) • • American Express [ Discover : MasterCard Visa Account Number Credit Card Billing Zip Code Expiration date — Month Year Amount $ Signature Company Name

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n section. Mail the form to the address on the reverse side of this form along with the filing fee. The fee is payable by check. VISA, MasterCard or American Express. Checks must be payable to the "Department of State". Credit Card/Debit Card Authorization forms can be found on our website at www.dos.ny.gov. This

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