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(Note:
The
information
you fill in for Section 1 will appear on your
permit.)
Section 1 Name:_________________________________________________ gender: (M or F)_____ height ________ Color of: eyes _____ hair _____ Birth:(mm/dd/yy)_______________ Legal residence (outside the U.S.A.): ____________________________________________________ If you have no preferred legal residence outside the U.S.A., San Jose, Costa Rica will be used. Types of Conveyances you Drive (check whatever applies): Motorcycle____ Automobile____ Light Truck____ Heavy Truck____ Passenger Bus_____ (optional) Use custom ID number on card: __________________ Section 2 I, the undersigned, affirm and understand that this application constitutes my request for a custom made identification. This is a contract and/or agreement, wherein for consideration given, the producer of said identification will make a custom ID containing all the information provided by me on this form. This application is for a wallet-size International Driver's Permit (IDP) valid for (4) years, from: WORLDWIDE TRAVEL ASSOCIATION of San Jose, Costa Rica. I, the undersigned, affirm that I have all the necessary skills to safely operate a motorized conveyance, and understand that I may be bound by the International Law(s) which govern the use and possession of said (IDP). By signing below, I accept full responsibility for any and all of my actions and deeds. I herein acknowledge that the producer, it's agents and/or representatives of WORLDWIDE TRAVEL ASSOCIATION are hereby indemnified and immune to any and all liabilities as a result of my use or misuse of the ID product requested. _______________________________________________ (signature) Questions? Call 570-647-4400 Note:
If
item does not
reach you and Priority Mail with confirmation is
not checked, the
replacement cost is $50 if loss is claimed within
30 days. (It's very
rare that a package goes astray.) Credit Card, PayPal payments: Send us your order form by copying & pasting it into an e-mail and filling in the requested information or e-mail with your photo in a .jpg or .gif format to justyce4all@ymail.com. Click here for payment page. ORPlease send this form with 2 passport photos and a money order, or business check or personal check (will delay processing), for $110 or $85 if ordering a passport-size also, payable to: Penny Pincher Press 1143 Northern Boulevard, #154 Clarks Summit 18411 Pennsylvania For overnight mail back to you, add $20. Send finished IDP to: Name:___________________________________________________________ Mailing Address:___________________________________________________ ____________________________________________________ Phone: (___)_________________ E-mail:___________________________ (in case we have questions about your order) |