Order Birth Certificate Online | USBirthCertificate.net

1. Birth Certificate Holder Details

Please confirm birth holder's state/region of birth is below

For this birth state, the state authority requires that the credit card address must match your shipping address. It will not be processed without this requirement.

Your relationship to the birth certificate holder?*

Enter the name of the birth certificate holder as it appears on the certificate…

Birth Holder First Name*

Birth Holder Middle*

Birth Holder Last*

Suffix*

Birth City*

Birth County or Borough*

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.; or 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?*

Is Certificate Holder Alive?*

2. Parent Information

Mother’s Maiden name (and 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.

Mother's First*

Mother's Middle*

Mother Maiden Last Name*

Father's name is:*

Known

Not listed or Unknown

Father's First Name*

Middle*

Father's Last*

Suffix*

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: The state requires that the credit card address must match your physical address. No exceptions.

"Ship to" Full Name*

"Ship to" Address*

City*

State*

Zip*

Cell phone*

Second Phone

Email*

Enter Email Confirm Email

4. Requester's Verification

That’s you, the person making request.

Your First Name*

Middle*

Your Last*

Suffix*

Reason for request*

Your Date of birth*

Pick: Month/Day/Year (not today’s date)

Your Social Security Number*

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):

Driver's License / ID No.:*

(or “I don’t have one”)

Texas ID Audit No. (from Driver's License):*

(See image above for the appropriate number location or tell us: “I don’t have one”)

Driver's License/ ID Street Address*

(You must duplicate exactly, letter-for-letter, what your driver’s license address shows)

City*

State*

Zip*

5. Costs and Order Options

Coupon Code

State fee

Additional Birth Certificates?

Cost per additional certificate

I would like to get extra copies of the birth certificate…

US Birth Certificate.net expedite fee

Price:

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 potentially one business day on the total time.

6. Payment Info

Credit Card address must match (please check to confirm)*

For this birth state, my credit card address matches the shipping address, as required by state rule.

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, (An expired card is one of the top things that has historically delayed an order.)

CVV Number*

3 digits on back

Amex CVV Number*

4 digits on front right

Name on Card*

Credit Card billing address is*

Same as shipping address above

Different address

Credit Card Billing Address*

City*

State*

Zip*

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.

I understand that unless stated otherwise, two separate charges will appear on my credit card (an expedite fee and a state/district charge)

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.

Please hit the submit button below only once.

Verification*

Confirm to indicate agreement to terms

Phone

This field is for validation purposes and should be left unchanged.

Birth Certificate Order form

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1. Birth Certificate Holder Details

2. Parent Information

3. Contact Information

4. Requester's Verification

5. Costs and Order Options

6. Payment Info

7. Verification of info submitted

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