Certified Birth Certificate

EZ Birth Certificate . Com

What you will need to do is fill out the form below and hit the print button on your browser.Then make a copy of your driver’s license or your state issued identification card (if available) and fax both to us at 713-629-0396 or 713-785-1458. The box below that says V-Code means the last three numbers on the back of your Visa/Mastercard in the signature box. We cannot obtain birth certificates for Connecticut, New Mexico or Hawaii.

PLEASE USE CAPITAL LETTERS ON THE FORM BELOW
All Sales Final
Fees: State Fee: $25.00-49.00 Plus Our Fee: $45.00
Please charge me "total service fee $137" for passport and birth certificate processing
Emergency Birth Certificate Processing (additional fee $25.00)
2-3 Day California walkthrough service, ALL fees included $136.00
Certified Birth Certificate Request

Credit Card Number:	Expires
Person's Name on Credit Card:	V- Code ( Required)

Credit Card Billing Address:

CityState Zip

Certificate Holders Name at Birth ( or adopted name):

(First)(Middle)(Last)

Fathers Name:

(First)(Middle)(Last)

Mother’s Full Maiden Name:

Maiden Last Name

(First) (Middle)(Last)

Birth Date State of Birth

County of Birth City of birth
Adopted or Legal Name Change
If adopted use adopted name and adopted parents names, Pre-adopted certificates are unavailable.

Hospital: Sex: Number of Copies

Ship Method: Express Courier Date of departure:

Ship to Name:

Ship to Address:***
( No P.O. Boxes )

CityState Zip

Daytime Telephone # () - - Extension:
Email:

Signature:___________________________________ Date

I authorize EZ Birthcertificate.Com to obtain my birth certificate for me.
I understand that USBirthcertificate.Com is not responsible for any service
performed by any overnight courier service
Please contact us if the certificate does not arrive by the stated process time

All Sales Final
PLEASE FAX A COPY OF YOUR DRIVERS LICENSE IF AVAILABLE
(FOR MINORS PLEASE FAX A COPY OF THE PARENTS' LICENSE)

***You must list a physical street address (No APO's , FPO's or PO Boxes) where someone can sign for the certificate

Additional Information: Please Note Any Special Instructions below
If your shipping address is a business address, please list the business name below.

If you will not be at your shipping address to sign for the overnight courier package when it arrives then you will need to leave a SIGNED letter on your door stating to please leave the package at your door or wherever you specify.

International Shipping Address:

Name

Phone#

Street Address

City

State / Province

Country

Zip / Postal Code

For International Shipping
Please leave the shipping address blank on the birth certificate order form. You will have an additional Federal Express shipping charge placed on the credit card listed above.

PLEASE FAX A COPY OF YOUR DRIVERS LICENSE IF AVAILABLE (FOR MINORS PLEASE FAX A COPY OF THE PARENTS' LICENSE)
Please lighten and enlarge the copy of your drivers license before faxing. No scanned images please.

Please contact us if the certificate does not arrive by the stated process time.

We can not process this request without a signature.
Please sign before faxing.

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