Copyright © 2008 IDL International, Inc., All Rights Reserved Updated: February 13, 2008 

International Driver's License Application For Email Transmission and Expedited Delivery

1. Last name: Patterson

2. First Name: Timothy

3. Current Driver's License Address:

1802 Parkway Street Apt. # 178 San Diego, CA 90121

4. Address to Mail IDL: 1802 Parkway Street Apt. # 178 San Diego, CA 90121

5. Email Address: *****************

6. Telephone: 215-649-0154

7. *Passport #:

8. *Passport Date of Issue#: 4/15/1999

9. *Passport Place of Issue: New Orleans, LA

10. Place of Birth: Baton Rouge, LA

11. Date of Birth: 1/16/1979

12. Nationality: American

13. Driver's License #: a1234567

14. State of Issue: CA

15. Date of Issue: 12/20/2005

16. Expires On: 12/20/210

I understand that this international driver's license is in no way intended to replace a suspended or revoked driver's license from the United States or any other country, and I am not applying for this international driver's license to use as such. I do further understand that this international driver's license will become null and void if a license is issued and the above is the actual Intention of the applicant. I further release IDL International, Inc. from any and all said liability caused by any misrepresentation on my part. I additionally release IDL International, Inc. from any and all liability caused by applicant's failure to comply with any local, state, national, or international law. IDL INTERNATIONAL'S LIABILITY LIMITED TO THE REFUND OF LICENSE FEE. 17.Applicant Signature:

Timothy Patterson

* Not Mandatory

Copyright © 2008 IDL International, Inc., All Rights Reserved Updated: February 13, 2008 

Credit cards (VISA, MasterCard or American Express) are accepted for YOUR convenience. All credit card transactions will be billed an additional $5.00 per license to offset processing fees.

Credit Card Authorization

Credit Card #: 341406194234099

Expiration Date: 02/2010 Name on Credit Card: Timothy Patterson Billing Address of Credit Card:

1802 Parkway Street Apt. # 178 San Diego, CA 90121

Authorized Card Holder Signature:

Timothy Patterson