Contact Information Company Name: ______

Mailing Request Form www.XpressVisa.ca ExpressVisa.ca Mike Consular (Visa) Express Services Inc. Tel:514-769-4949 Fax:514-769-2512 Complex Guy-Favreau, 200 Rene-Levesque W, Level 00, Suite 15, Montreal, Qc. H2Z 1X4

Name: Mr. Ms. ______

Mailing Address: ______

City: ______Province: ______Postal Code:______

Tel: ______Cell: ______Fax: ______Please attach your business card e-mail:______

Visa or Country Passport Time (days) Note: E.g.: Passport issuing Document Request Number Qty Required Price country if not in Canada

Photo Taken X $10 Mailing in Canada X $35 When mailing to the embassy or consulate is required, the fee will be Mailing to US X $55 adjusted. Handling applicant provided return envelop, account No. X $10 Signature of Payment Payment Type Total: Received by: Required Mailing Date NOTE:

*We only use FedEx, Purolator or Canada Post XpressPost to ship your documents. Signature: ______Date: ______Mailing Request Form www.XpressVisa.ca ExpressVisa.ca Mike Consular (Visa) Express Services Inc. Tel:514-769-4949 Fax:514-769-2512 Complex Guy-Favreau, 200 Rene-Levesque W, Level 00, Suite 15, Montreal, Qc. H2Z 1X4

Visa Card or Master Card Information:

Card Holder’s Name:

Card Number:

mm / yy Expiry Date: Amount Required: Please remember adding the fees for Photo, Mailing, or Pickup & Delivery to the amount required. Signature: ______Date: ______