------FORM STARTS ------USMC CID CREDENTIALS– DATA FORM ------

Fill one form for each id card you purchase – read the instructions before!

IF YOU HAVE ORDERED LAMINATION, REMEMBER THAT CARDS CANNOT BE FURTHER CUSTOMIZED ONCE LAMINATED

- FILL WITH ‘X’ THE BRACKETS [ ], IF YOU WANT THE CORRISPONDENT OPTION TO APPEAR ON THE ID

CARD. IF YOU DO NOT WANT THE OPTION, LEAVE THE BRACKET BLANK

-IF YOU WANT TO LEAVE BLANK A FIELD ANSWER WITH: ‘N/A’

- IF YOU WANTTO LEAVE US TOINSERT SOME DATA (FOR EXAMPLE ‘CARD NUMBER’ OR ‘SERVICE NUMBER’) THEN ANSWER WITH THREE SLASHES: ‘///’ONLY FOR TYPE OF CARD AND GENERAL DATA SECTIONS

CARD WILL BE FILLED WITH COMPUTER

PLEASE FILL ALL SPACES

CUSTOMER NAME:

write the same name shown on your paypal home address

TYPE OF ID CARD

mark ONE of the following options

-USMC CID CREDENTIALS, ‘70 [ ]

-USMC CID CREDENTIALS, RETIRED PERSONNEL, ‘70 [ ]

-USMC CID CREDENTIALS, ‘80 [ ]

-USMC CID CREDENTIALS, RETIRED PERSONNEL, ‘80 [ ]

PHOTO SECTION

NOTE: PHOTO WILL BE PRINTED IN “BLACK & WHITE”

PHOTO REQUIRED (ANSWER WITH ‘YES’ OR ‘NO’):

IF ANSWER IS ‘YES’please send the photo together with this form (or insert it in the white space on last page of this form), to the email address shown in the contact us section on (.JPG OR .BMP FORMAT, NO LOW RESOLUTION IMAGES)

GENERAL DATA SECTION

NAME TO APPEAR ON CARD:

CARD SERIAL NUMBER:

SIGNATURE OF BEARER SECTION

SIGNATURE OF INVESTIGATOR (BEARER OF CARD) REQUIRED [ ]

IF YOU MARK THIS OPTION, please send the scansion of the signature together with this form (or insert it in the white space on last page of this form), to the email address shown in the contact us section on (.JPG OR .BMP FORMAT, NO LOW RESOLUTION IMAGES)

ADD SIGNATURE OF INVESTIGATOR (BEARER OF CARD) FOR ME [ ]

Option AVAILABLE only if you have NOT MARKED the ABOVE OPTION.By selecting this option, you do not have to attach any image, we will provide to sign the card. Signature will read the same first name, last name and middle name initial specified above.

NO SIGNATURE OF BEARER REQUIRED [ ]

NO SIGNATURE OF BEARER WILL APPEAR ON CARD

SIGNATURE OF ISSUING AUTHORITY SECTION

SIGNATURE OF DIRECTOR (ISSUING AUTHORITY) REQUIRED [ ]

IF YOU MARK THIS OPTION, please send the scansion of the signature together with this form (or insert it in the white space on last page of this form), to the email address shown in the contact us section on (.JPG OR .BMP FORMAT, NO LOW RESOLUTION IMAGES)

ADD SIGNATURE OF DIRECTOR (ISSUING AUTHORITY) FOR ME [ ]

Option AVAILABLE only if you have NOT MARKED the ABOVE OPTION.By selecting this option, you do not have to attach any image, we will provide to sign the card.

PLEASE SPECIFY HERE name (and rank if you want it to appear) of issuing authority:

NO SIGNATURE OF ISSUING AUTHORITY REQUIRED [ ]

NO SIGNATURE OF ISSUING AUTHORITY WILL APPEAR ON CARD

REMARKS

-ONCE YOU WILL GIVE US YOUR DATA AND THEY WILL BE PRINTED ON THE ID CARD THEY CANNOT BE REMOVED OR MODIFIED IN ANY WAY. SO PLEASE CHECK DOUBLE TIME THE INFORMATION YOU GIVE IN THIS FORM.

INFORMATION PROVIDED IN THIS FORM WILL REMAIN STRICTLY CONFIDENTIAL

------FORM ENDS ------USMC CID CREDENTIALS– DATA FORM ------

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