Please initial next to each of the requirements below.
DS-4085 Passport Pages Application
Complete and sign the DS-4085. (sign in blue or black ink)
Print one copy of your travel itinerary, business letter or other intent to travel.
Passport must be in good condition. It will not be accepted if damaged or mutilated. NOTE: Your passport must have more than one year of validity left to qualify for additional pages.
A check or money order made payable to the "US Department of State" in the amount of $142.00. Temporary or starter checks will not be accepted. Note: Make sure that you spell out the check amount in the proper format (One Hundred Forty-two and 00/100).
All checks submitted must include a pre-printed address (sign in blue or black ink)
Print and sign one copy of the authorization letter. This allows us to act as an agent on your behalf. This will be emailed to you by your passport specialist by calling 866-895-9137 when it is confirmed that you have all required documentation. (sign blue or black ink only)
FedEx Shipping Label
Please print out your pre-paid FedEx shipping label. You must use either Microsoft Internet Explorer or Mozilla FireFox. Fold label in half and place into the plastic shipping pouch outside of a FedEx envelope which can be obtained at any authorized FedEx shipping location. Make sure the label and barcode are visible. We do not not accept any other form of shipment - you must use FedEx. This will be emailed to you by your passport specialist when it is confirmed that you have all required documentation. If you have problems printing your FedEx shipping label, please contact your case manager.
NOTE: Your passport application may be denied if you are in arrears of child support or have been notified by the IRS of owing back taxes.
I hereby certify that I have preformed the above requirements to the best of my ability.
I understand that the U.S. Department of State could suspend my case in the event that my package is incomplete.