Order

Birth Certificate Order Form

The form is 100% secure.

Once your order is placed, you’ll see an “Order successfully transmitted” page and receive email confirmation within a few minutes. Your order will start processing soon after we receive it. A second email with sales receipt will be sent within two business days.

Your birth certificate will be delivered by the shipper indicated on your state page. Average delivery times are listed there too. Be sure that you or someone you trust is there to receive and sign for the shipment.

Note: Two charges will appear on your credit card, a state fee, plus our expediting fee of $59. Also, you cannot use non-US issued credit cards or ship outside the USA.

ALL SALES ARE FINAL. Once a job is received by our office, it can’t be cancelled. And be ready. We may call you to verify info to help get it through the system accurately and quickly!

Section 1. Birth Certificate Holder Details
Enter the name of the birth certificate holder as it appears on the certificate...
Birth Holder First Name*

First name at birth
Birth Holder Middle*

(or enter "None" or "Unknown")
Birth Holder Last*

Last name at birth
Suffix*
(or "none")
Birth City*
Birth County or Borough*
Birth State*
Gender*
- Male
- Female
Certificate Holder's Birth Date*
NOTE: To prevent delay, be sure the date entered is:
a) Not today's date;
b) If it is your own certificate you are requesting, use your D.O.B.;
c) If it is for someone else, use that person's D.O.B.
Birth Hospital

(if name is known)
Adopted or Legal Name Change?*
Name change after birth (not marriage)?
Is Certificate Holder Alive?*
Section 2. Parent Information
The Mother's Maiden name and the Father (if known)
IMPORTANT NOTE: To avoid delays, make sure the mother's maiden name is put below. Also, list the father's name if it is known and on the record of birth.
Next, please enter the birth mother's maiden name...
Mother's First*
Mother's Middle*

(or enter "None" or "Unknown")
Mother Maiden Last Name*
And, the Father of Record...
Father's name is:*
- Known
- Not listed or Unknown
Select one
Father's First Name*
Middle*

(or enter "None" or "Unknown")
Father's Last*
Suffix*
(or "none")
Section 3. Contact Information
IMPORTANT NOTE: No PO Boxes. You must list a physical street address below (Also, no APO’s or FPO’s). It must be delivered to where someone can sign for the certificate.

Also, if the certificate holder was born in CO, KS, LA, MD, MI, ME, MO, NH, NY, NC, PA or VA, the address must match the credit card billing address. No exceptions.
"Ship to" Full Name*

Both first and last name that should appear on the envelope with the birth certificate in it
"Ship to" Address*

Physical Address (no PO Boxes)
City*
State*
Zip*
Daytime Phone*

Best number for immediate contact!
Second Phone

The next best number to reach you
Email*
Enter Email Confirm Email
Section 4. Requester's Verification
That's you, the person making request.
IMPORTANT NOTE: The order can't be processed without your complete name here and may be delayed if left blank.
Your First Name*
Middle*

(or "none")
Your Last*
Suffix*
(or "none")
Your relationship to the birth certificate holder?*
Reason for request*
Your Date of birth*
Month
Day
Year

Pick: Month/Day/Year (not today's date)
Your Social Security Number*
States require specific identification information off your most recent State issued ID or Drivers's Licence:
Driver's License / ID No.:*
State that issued your Driver's License or ID?*
Above are examples of the two numbers needed from your State Id or State driver's license:(Audit number is a second number needed from Texas ID's or your TX Drivers License):
Texas ID Audit No. (from Driver's License):*

(See image above for the appropriate number location)
Driver's License/ ID Street Address*

Address (You must duplicating exactly, letter-for-letter, what your driver's license shows)
City*
State*
Zip*
Section 5. Order Options
Additional Birth Certificates?
I would like to get extra copies of the birth certificate...
Select birth state to display the extra-per-copy charge*
Expedite a passport too?
Hidden
I would like you to also provide an expedited passport.
In addition to an expedited birth certificate, here you have the option of adding a passport.
Hidden
Expedite Passport and birth certificate?
This includes the $59 expedite birth certificate cost plus a $116 passport expedite fee for a total of $175.
The "state fees" listed are an additional cost.
Emergency Processing? Additional $25
Emergency Processing: (Regular expedite fee of $59, plus this optional fee of $25.00 for a total of $84
for the expediting fee). Emergency processing will not change the State's processing time. It puts your
job in front of regular jobs that came in before it, saving about 1 business day on average.
Section 6. Payment Info
Credit Card Type*
Credit Card Number*
Amex Card Number*
Card Expiration*

Format: mm-yy
Please Repeat Card Expiration*

Entering this date again will help verify that the card is current, especially after a browser has auto-fills the card information. (An expired card is one of the top things that delays an order.)
CVV Number*

3 digits on back
Amex CVV Number*

4 digits on front right
Name on Card*

Exactly as it appears
CAUTION: The credit card address must match the credit card billing address if the certificate holder was born in CO, KS, LA, MD, MI, ME, MO, NH, NM, NY, NC, PA, or VA.)
Credit Card billing address is*
- Same as shipping address above
- Different address
Credit Card Billing Address*
City*
State*
Zip*
Coupon Code
Section 7. Verification of info submitted
To help avoid unnecessary delays, please check each item after confirming it to be the case:
Verification*
- The "ship to" name matches the requester's current name that is requesting the certificate.
- The mother's MAIDEN name was used in the last name of the "Mother's Name" field above.
- The father's name was filled out, if it is known.
- If the birth state is one of the following states: CO, KS, LA, MD, MI, ME, MO, NH, NM, NY, NC, PA or VA, the shipping AND billing addresses each match as required by local state law... or this doesn't apply to my certificate request state.
- I understand that unless stated otherwise, two separate charges will appear on my credit card (an expedite fee and a state/district charge)
- If a "success" page doesn't result after submitting, it means there are errors or information missing. These will be highlighted with red boxes. Once fixed, click "Submit" again.
I authorize USBirthcertificate.net to expedite my birth certificate for me. By pressing the submit button below I agree that I have read the order form completely and if the information that you have provided is incorrect, insufficient, or the government agency has no record of the birth that there are no refunds of USBirthcertificate.net's expedite services fee for any reason. I understand that USBirthcertificate.net is a private expediting service and I am hiring them to expedite my birth certificate order. (We don't create, change or amend birth records. We only help you retrieve existing records.) ALL SALES ARE FINAL. By clicking the submit button below you are sending your information electronically to our office so we can process your order. Once you click the button below your order will be processed by our office and cannot be cancelled. By clicking the button below you agree to these terms and the terms above. To send your order to our office please hit the submit button below only once
Once the agreement is confirmed, click the submit button below. Be sure you get to the success page (otherwise check form for missing info.)*
- Yes, I agree to these terms. Go ahead and place my order.
Once the agreement is confirmed, click the submit button below. Be sure you get to the success page (otherwise check form for missing info.)
Phone
This field is for validation purposes and should be left unchanged.

Section 1. Birth Certificate Holder Details

Section 2. Parent Information

Section 3. Contact Information

Section 4. Requester's Verification

Section 5. Order Options

Section 6. Payment Info

Section 7. Verification of info submitted