as it appears on the card: Billing Address: City: State Zip: Signature: Payment Via Approved Billing Terms G3 Customer Number, Billing, P.O., Project or Reference Codell: x Concierge Service Require Total Fees from Applicable Fees Page Concierge Fee US Government Fee G3 Service Fee Passport Protection Plan FEE

ature: Return Delivery Fee Subtotal L Payment Via Approved Billing Terms Add 5% for credit card convenience fee G3 Customer Number, Billing, M., Project or Reference Codell: —1 Total Payment Enclosed - 1 2 4 Visa S - Visa Type: li Tourist 0 Business 0 Flight Crew 0 Other Processing Speed: 0 Mission Critical 0