PLEASE NOTE: ALL CORRESPONDENCE BY FAX OR E-MAIL ONLY

Globe Language Services, Inc.

319 Broadway, 2^nd Floor

New York, NY 10007

Tel: (212) 227-1994

Fax: (212) 693-1489

www.globelanguage.com

Translation from what language:	__________________
	(please specify)
Translation into what language:	__________________
	(please specify)

FOR OFFICE USE ONLY

FILE NAME ______________________________________

DUE DATE ______________________________________

APPLICATION FOR TRANSLATION

Mr. Ms. [_____________________________]_[______________________]_[____________________________]

(Last Name on the Document[s]) (First Name on the Document[s]) (Middle Name on the Document[s])

__________________________________________________________________________________________

(Any Other Names on the Document[s])

Your Phone Number: (____)___________________ E-Mail Address: ________________________________

Your Address: _____________________________________________________________________________

__________________________________________________________________________________________

Please check one that apply: Pick-up _____Mail _____Fax _____ #:_________________________

FEES:

Translation $________________ (Check translation prices: Click Here!)

Regular Service (5 business days)___

24-48 Hour Rush Service $_______ (25% of translation fee)

Additional Copies ____________ ($20 each with this request, $40 each when requested at a future date)

Express Mail Service _________ ($30)

Fees are non-refundable.

Applicant Signature: ________________________ Date: _____/_____/_____

Month Date Year

CREDIT CARD AUTHORIZATION
*Payment must be made by US Money Order or Credit Card. (No Personal Checks/No Debit Cards).* *(No 3^rd Party Credit Cards Accepted)*
AUTHORIZED AMOUNT $___________
TYPE OF CARD: Visa ⁪ / MasterCard ⁪ / Discover ⁪ / American Express ⁪
CARD NUMBER _______________________________	CARD EXPIRATION DATE ____/____
BILLING ADDRESS __________________________________________________________________
CARDHOLDER NAME ______________________ CARDHOLDER SIGNATURE _____________________
CREDIT CARD CODE# __________________________________________________________________ *(3 number located on back of card or 4 numbers on AMEX on the front of the card)*

NOTES:

After you review your translation, if you feel any changes are necessary, please advise us in writing immediately. Please provide supporting documentation for all proposed changes. No changes will be made unless they are fully documented. After one month from the date the translation is issued, a fee for any change will be charged.

FOR OFFICE USE ONLY
Total fee: $
Total number of pages for translation:
Credit Card Receipt Number:		Mailed on:
Money Order:		Picked up on:

PLEASE NOTE: ALL CORRESPONDENCE BY FAX OR E-MAIL ONLY

APPLICATION FOR TRANSLATION

CREDIT CARD AUTHORIZATION

AUTHORIZED AMOUNT $___________

NOTES: