BCV Visa and Passport Service
BCV Visa and Passport Services
www.bcvisa.com
1-888-778-6182
Credt Card Order Form
Credit Card Information
*Credit Card Type:
*Credit card Number:
Expiration Date:
Amount
Card Identifier (CVV/CVC No:)
Card Billing Information
*Card Hold First Name:
*Card Hold Last Name:
*Billing Address 1:
Address 2:
*Zip:
*City:
*State:
*Phone Number:
Emai Address :
Payment by Credit Card subject to 3% processing Charge.  
I have read and agreed to the terms and conditions listed BCV website. I understand that all fees are non-refundable once my
application was submitted to the Consulate for processing. I authorize BCV Visa and Passport Service to charge the amount due as
listed above plus processing fee of 3% of total amount  to my credit card.
Please print the page and send it to us with your application form