Please print, fill out and sign the appropriate number of authorization forms.
(two for new passports or to replace lost passports ... one for renewals and changes)

I,
	authorize Passport & Visa Exchange to process and pick up the passport of my:
son/daughter:
Date of Birth:
Signed: (both parents)
Signed: (child)
	All signatures must be original & and signed in blue ink. Passport & Visa Exchange 2801 Ridge Road Drive Alexandria, Va. 22302 703-739-0974