MD Visa Plus Order Form
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CONTACT INFORMATION
Title
--
Mr.
Ms.
Mrs.
Dr.
Last Name
First Name
Phone Number
Email
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RETURN SHIPPING INFORMATION
Name
Company
Street
Suite/Apt #
City
State
Select State
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Zip
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VISA SERVICE INFORMATION
Last Name
First Name
Nationality
U.S. Citizen
Non-U.S. Citizen
Country
Select Country
China
India
Brazil
Other
Travel Purpose
Tourist
Business
Student
Work
Crew (China Only)
Travel Permit (China Only)
Visa Transfer (India Only)
Authentication (China Only)
Visa Type
Select Visa Type
China- Multiple Entry, 10 Years
China- Multiple Entry, 6 Mon
China- Double Entry, 6 Mon
China- Single Entry, 6 Mon
India- Multiple Entry, 6 Mon
India- Multiple Entry, 1 Year
India- Multiple Entry, 5 Years
India- Multiple Entry, 10 Years
Brazil- Multiple Entry, 10 Years
Other
Service Type
Select Service
Regular
Express
Rush
Names of Additional Applicants
Total Number of Applications
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PAYMENT INFORMATION
Total Consular Fee
Total Service Fee
Return Shipping Fee
Select Return Shipping
$0, Prepaid Airbill or Envelope Enclosed
$35, FedEx Express
Total Amount Due
Payment
Select Payment
Check
Money Order
Credit Card
Personal check, business check and cashier's check are accepted. The financial charge
for a returned check
is $20.
Credit card payment is subject to a 3% processing charge. Please fill out and send CREDIT CARD PAYMENT FORM to pay by credit card.
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COMMENTS
How Did You Find Us?
Select One
Google
Yahoo
Other Search Tools
Travel Agent
Friend
Repeat Customer
Promotion Mail or Email
Other
Comments
Please print two copies of this order form. Keep one copy for your record and place the other copy in the package you will send to us.