Please carefully read the information below before completing this Letter of Authorization.
An individual's personal information cannot be released by the U.S. government to another party without the written consent of the individual under the provisions of the Privacy Act of 1974 (5 USC 552a). As a result, an employee at a U.S. passport agency cannot discuss the details of your passport application with a third party without your written consent.
Please circle all that apply:
I authorize the company stated below to submit my passport application to a passport agency and pick up the passport from a U.S. passport agency on my behalf.
I authorize the passport agency to disclose to the company listed below any requests for further documentation and/or information that may arise in connection with my passport application, and I authorize the company to respond to such requests under my direction.
I do not authorize the passport agency to disclose to the company listed below any requests for further documentation and/or information that may arise with my passport application. I want the passport agency to contact me directly should an issue arise with my passport application that concerns matters other than the date on which the passport will be ready for pick-up from the passport agency.
(Note: All of the information below may ONLY be filled out by the applicant, parent, legal guardian, or person legally acting in loco parentis)
1-773-384-5375 2048 N. Stave St. Chicago, IL 60647-4025
Bucktown Visas & Passports, Inc. is not responsible for any delays, lost documents, lost passports, or any material associated with the process of expediting international travel documents. We are not responsible for the actions of the United States Passport Agency or any Consulates or FedEx. Damage compensation is not available. All Agency rules and fees are subject to change without prior notice. All government fees are nonrefundable. Rules and fees are for U.S. citizens only. All Bucktown Visas & Passports, Inc. fees are payable in cash, money order, cashier's check, company check, or with Visa, Mastercard, or American Express.