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DOCUMENT LEGALIZATION SERVICES ORDER FORM
Please send us this form along with your documents to:
Apostilla.com, Inc.
60 East 42nd Street
Suite 3502
New York, NY 10165
Tel. (646)-536-2742
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PERSONAL INFORMATION:

1. Today’s date: ______ / ______ / ______      

2. Client ID (Optional)______________________*Just In case that we have already assigned it to you

3. Your Name:                                                                                                                       ___

4. Phone Number:                                                                                                                  ___

5. E-mail Address:                                                                                                                   __

6. Please provide us with the mailing address where you would like us to return your documents:

Name: _____________________________________________________________________________

Company name (optional):_____________________________________________________________

Street address: ______________________________________________________________________

City/State/Zip: ______________________________________________________________________

Country: ___________________________________________________________________________

ALTERNATE CONTACT INFORMATION: (Optional)

Name: _____________________________________________________________________________

Phone Number: ______________________________________________________________________

Email address:_______________________________________________________________________

DETAILS OF DOCUMENTS:

1.  Country document(s) will be used in: __________________________________________________

2.  Please list the documents you are seding to us: _________________________________________

___________________________________________________________________________________

___________________________________________________________________________________

3. Number of Apostilles / Legalizations required:____________________________________________

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FEES DEPENDING ON THE SERVICES REQUIRED:

APOSTILLE - $200 USD per Apostille
Includes: * Notary, * Notary Certification and Secretary of State Apostille.
US DEPARTMENT OF STATE AUTHENTICATION - $400 USD per US Dept. of State Authentication
Includes: * Notary, * Notary Certification, Secretary of State Legalization and US Department of State Authentication in Washington, D.C.
EMBASSY LEGALIZATION - $500 USD per Embassy Legalization
Includes: * Notary, * Notary Certification, Secretary of State Legalization, US Department of State Authentication and Embassy Legalization.
* When required.
FedEx of the documents back to you included in all services -domestic or international-

PAYMENT OPTIONS: (please check one of the boxes).

□ Make check or money order payable to “Apostilla.com, Inc.” in US Dollars.
□ Pay with a credit card.  * Please fill out the credit card authorization form below.
□ Western Union wire transfer. * Please fill out the Western Union form we will provide to you.
□ Bank deposit: Bank of America (United States), BBVA (Europe) or Banamex (Latin America).
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CREDIT CARD AUTHORIZATION FORM

This payment is for: Apostille or Embassy Legalization services provided by Apostilla.com, Inc.

Today’s date: ______ / ______ / ______

Cardholder’s Name: __________________________________________________________________

                                                                 (as it appears on the card)

Credit Card Number:__________________________________________________________________

Expiration Date:______________________________________________________________________

Security Number:_____________________________________________________________________

(3 digits for Visa and Mastercard - 4 digits for American Express)

Cardholder’s Billing Address:___________________________________________________________

Telephone Number: __________________________________________________________________

□ VISA          □ AMERICAN EXPRESS       □ MASTERCARD

 I,_______________________________________, give authorization to apostilla.com  to charge my

credit card account given above for the following payments.

Type of Service

How Many

Amount

Apostille $200

  

$

Notary Certification $100
FREE

$ --------------------

US Department of State $400

  

$

Embassy Legalization $500

  

$

TOTAL:

$

By signing below, cardholder acknowledges receipt of services described above in the amount of the total shown herein and agrees to perform the obligations set forth in the Cardholder’s agreement with the issuer.

Cardholder’s Signature: ______________________________________________________

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