Fiance Visa Support Printable Order Form

Fiance Visas Support Order Form

Please print the following form and return it by mail with your correct payment by check, money order or Credit Card. If paying via credit card you may also fax this form to 1-858-481-2143 instead. All checks must be in US dollars payable on a USA bank. You may also send cash, however if you do so, please only send it by registered mail. Please mail to:

Heart of Asia

PMB# 131, 2658 Del Mar Heights Road,Del Mar, CA 92014 USA.
Tel: 1-800-806-3210 ext 404, or 1-858-720-0203 ext 404

Name:___________________________________________________________
Address:________________________________________________________
City:_________________________State/Prov:_______________________
Country:_________________________Zip Code:______________________
Phone:_______________________Fax:_______________________________
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E-Mail Address:_________________________________________________

Prices For Visas support in US $

DIY Basic Fiance Visa Support Package              $  125              _________

DIY PLUS Intermediate Fiance Visa Support Package  $  350              _________

FULL Fiance Visa Support Package                   $  575              _________

DIY Basic Spousal Visa Support Package             $  125              _________

DIY PLUS Intermediate Spousal Visa Support Package $  550              _________

FULL Spousal Visa Support Package                  $  875              _________

Total Enclosed _________

I understand and agree that Heart of Asia is not an Attorney,
Immigration Law Firm, or employee of the I.N.S. Heart of Asia's consultant who
will be providing the visa support service is also not an attorney, law firm 
or employee of the INS.

Signature required:__________________________Date:_____________

Payment Method
___ Money Order (US$ payable on US Bank) ___ Personal Check (US$ drawn on US Bank)(Order held 2 wks for clearing) ___ International Postal Money Order(US$ Payable on US Bank) (Sorry No Canadian Postal Orders, these are not payable on a US bank) ___ Cash Currency US$ send via REGISTERED mail ONLY. ___ American Express Card ___ Visa ___ MasterCard____Discover

All payments should be in US $dollars. Checks or drafts should be issued by U.S. Banks made payable to Heart of Asia. Bankers Drafts are preferred. Personal checks are acceptable, however your order will be delayed 2 weeks pending clearing of check.

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Credit Card Information (Maximum Credit card payments accepted is $125)

Credit Card Number:_________________ Issue:_____ Expiry:______

Code on back of card____

Name on Card(Please Print):___________________________________

If paying by Credit Card please sign as follows: I hereby
authorise Heart of Asia to debit the above selected Credit Card by
the amount of $ _________US dollars.

Signature_________________________ Date _________________

Send to: 
Heart of Asia,PMB# 131 ,2658 Del Mar Heights Road,Del Mar, CA 92014 USA
tel 1-800-806-3210 ext 404, or 1-858-720-0203 ext 404

06/11/2003