PRINTABLE APPLICATION



PRINTABLE APPLICATION

Please print this form, fill out and send it with your payment to:

For official use only

Attention: additional charge $5.00 will apply if you fillout printable application by hand

no any additional charges if you apply online at

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|INFORMATION AS PRINTED ON YOUR NATIVE DRIVER LICENSE |MAILING ADDRESS (LEAVE BLANK IF THE SAME) |

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|First name: |___|___|___|___|___|___|___|___|___|___|___|___|___|___| |First name: |___|___|___|___|___|___|___|___|___|___|___|___|___|___| |

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|Last name: |___|___|___|___|___|___|___|___|___|___|___|___|___|___| |Last name: |___|___|___|___|___|___|___|___|___|___|___|___|___|___| |

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|Address: |___|___|___|___|___|___|___|___|___|___|___|___|___|___|___| |Address: |___|___|___|___|___|___|___|___|___|___|___|___|___|___|___| |

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||___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___| ||___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___| |

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|City: |___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___| |City: |___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___| |

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|State/Province: |___|___|___|___|___|___|___|___|___|___|___|___|___| |State/Province: |___|___|___|___|___|___|___|___|___|___|___|___|___| |

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|ZIP/Post Code: |___|___|___|___|___|___|___|___|___|___|___|___| |ZIP/Post Code: |___|___|___|___|___|___|___|___|___|___|___|___| |

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|Country: |___|___|___|___|___|___|___|___|___|___|___|___|___|___| |Country: |___|___|___|___|___|___|___|___|___|___|___|___|___|___| |

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|Date of Birth: _____|_____MM______|_____DD______|_______YY |CONTACT INFORMATION |

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|Country of Birth: |___|___|___|___|___|___|___|___|___|___|___|___|___| |E-Mail: |___|___|___|___|___|___|___|___|___|___|___|___|___|____|___| |

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|Gender(male, female) : __F___|___M____| (CIRCLE) |Phone: |___|___|___|___|___|___|___|___|___|___|___|___| |

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|Eye color: |___|___|___|___|___|___|___|___|___|___|___|___|___| | |

| |1 YEAR VALIDITY - $35.00 |

|Height: |___|___|____| CM |___| FEET |___| INCHES |3 YEARS VALIDITY - $40.00 |

| |5 YEARS VALIDITY - $45.00 |

|DRIVER’S LICENSE # |___|___|___|___|___|___|___|___|___|___|___| |10 YEARS VALIDITY - $50.00 |

| |10 YEARS VALIDITY (GOLDEN WITH ELECTRONIC CHEAP) - $110 |

|Exp. Date: _____|_____MM______|_____DD______|_______YY | |

| |5 YEARS NON GOVERNMENT ID CARD - $25.00 |

|Category : |_A_| MOTORCYCLES | |

| |INSURANCE FOR ALL OF IDL’s - $7.99 |

||_B_| PASSENGER CARS |INSURANCE FOR GOLDEN IDL - $14.99 |

| |HANDLING THIS APPLICATION - $5.00 |

||_C_| VEHICLES OVER 7,700 Lbs | |

| |International Shipping Rates Prices |

||_D_| VEHICLES OVER 8 SEATS | |

| |DHL International $ 45.00 |

||_E_| VEHICLES OF B,C, OR D with other that a light trailer |USPS Regular Mail $5.00 (3-4 weeks of delivery, trucking# is not available) |

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||___| NON GOVERNMENTAL ID CARD | |

| |United States Shipping Rates Prices |

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|To order an International Translation of Driver’s License for more than a one |USPS Priority mail $ 6.00 |

|year validity period you represent that your driver’s license will either be |USPS Priority mail ( trackable ) $ 8.00 |

|valid for such a period, automatically renewed or will renew your license in |USPS Express mail (Within USA) $ 19.00 |

|your country of origin. Validity periods maintain your validity status |UPS / FedEx Next Day Guarantee (Within USA) $ 26.00 |

|provided that the native original driver’s license is valid for that same | |

|period | |

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|Payment method |

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|Money order #__________________________________ |

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|Personal or Company Check #_____________________ |

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|Western Union #________________________________ Sender’s First and Last name ______________________________________ |

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|Credit or Debit card [pic] |

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|Name on the credit card |___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___| |

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|Card #: |___|___|___|___|___|___|___|___|___|___|___|___|___|___|___| Exp. date: |___|___| |___|___|___|___| |

|VISA, MASTERCARD, AMERICAN EXPRESS, DISCOVER MONTH YEAR |

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|For MasterCard or Visa the 3-digit CVV which |___|___|___|___| can be found after the account number on the back of the card |

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|Billing Address of CC |___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___| |

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||___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___| |

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|I, the client, confirm that my native driver’s license is valid, issued by a government entity, not subject to revocation or suspension. I acknowledge that |

|my International Translation of Driver’s License is not a standalone document, and must be go together with by my valid native driver’s license. I acknowledge|

|that it is my obligation to verify with the local authority the rights to use a translation of my native driver’s license. |

|Note: Applications without payment or credit card info cannot be processed |

|Be sure met all requirements for International Translation of Driver License: |

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|1. Signed Application |___| |

|2. One Photo (any sizes) |___| |

|3. Copy of Native Driver License (both sides) |___| |

|4. Payment |___| |

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|Do not forget include in payment shipping cost and $5 for handle this application |

|ATTACH ONE COLOR PHOTO (ANY SIZES) |SIGNATURE HERE (WRITE CLEARLY BELOW) |

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|ATTACH COPY OF YOUR NATIVE DRIVER LICENSE |

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For official use only

KRASCAR INTERNATIONAL TRAVEL CLUB INC.

1162 St. Georges Ave., Suite # 293

Avenel NJ 07001, USA

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