BCV
Visa and Passport Service
BCV Visa and Passport Services
1502 Rosalie St
Houston, TX 77004
www.bcvisa.com
1-888-778-6182
Credt Card Order Form
Credit Card Information
*
Credit card Number:
*Credit Card Type
:
Visa
Master
American Express
Expiration Date:
Amount
Card Identifier (CVV/CVC No:)
Card Billing Information
*
Card Hold First Name:
*
Card Hold Last Name:
*Billing
Address 1:
Address 2:
*
Zip:
*
City:
*
State:
*
Phone Number:
Emai Address :
Payment by Credit Card subject to 3% processing Charge.
I have read and agreed to the terms and conditions listed BCV website. I understand that all fees are non-refundable once my
application was submitted to the Consulate for processing. I authorize BCV Visa and Passport Service to charge the amount due as
listed above plus processing fee of 3% of total amount to my credit card.
