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Bucktown Visas & Passports, Inc.

We specialize in expedited Service!

Brazil Visa Order Form
Please ship documents via FedEx to:
Bucktown Visas & Passports, 2048 N. Stave St., Chicago, IL  60647-4025


**Fill out only the fields that pertain to your order. Anything that
doesn't pertain to your order you can just leave blank.
Online Payment Service

 

****NOTE: We are currently experiencing difficulties receiving our order forms.  Until our website host company corrects this problem, please print out your order form and ship it to us along with all of your other documents.  We are sorry for any inconvenience, and we thank you for your patience.****
First Name
Last Name
Date of Departure
Billing Address Line 1 - NOTE: Billing address must match credit card
Billing Address Line 2 - NOTE: Billing address must match credit card
City
State, Zip Code
Daytime Phone() -
E-mail Address
Ship to Address (if different than above) Line 1
Ship to Address (if different than above) Line 2
Brazil Consular Fees - Brazil Business Visa (allow 17-20 business days) - $160.00
Brazil Consular Fees - Brazil Tourist Visa (allow 17-20 business days) - $160.00
Form of Payment - AMEX, Visa, MC, Money Order, Company Check
Name on Credit Card
Credit Card Number
Expiration Date
Your own return Bill of Lading enclosed (type yes if applicable)
Total Amount of Consular Fees
Total Amount of Bucktown Expediting Fees
Total Amount of Bucktown Return Shipping Fees
Total Amount of Order
  1. For your convenience, you can pay the full amount of your Consular fees and your Bucktown Visas & Passports expediting and return shipping fees with a money order, cashier's check, company check (all payable to Bucktown Visas & Passports, Inc.), or by credit card in just one simple payment. We're sorry, Bucktown cannot accept personal checks.
  2. The Bucktown expediting and return shipping fees are in addition to your Consular fees.
  3. If you do not feel secure in filling out your credit card information, you may fill out this order form partially online, if you wish, and then print the form out in order to hand print, legibly, and in ink, your credit card information, if paying with a credit card.   If you want us to get a head start on your order, simply click on the "Send" button at the bottom of the order form.  Your order will be received by email.  But please also print out and enclose a copy of this completed order form with all of your other shipped documents.  Thank you!