Novelty Birth Certificate Order Form

☑ Add to cart

Novelty Birth Certificate - $39

Select Birth Certificate style

NOTICE: Your birth certificate will look like the sample shown above and will be 8.5" x 11". If this is not what you want DO NOT ORDER.

☑ Novelty Birth Certificate format

I understand my novelty birth certificate will be printed on 8.5" x 11" ivory card stock and will look like the sample shown above (https://fs18.formsite.com/documentservicesllc/images/fake_birth_certificate_style_1_new.jpg).

NOTICE: Your birth certificate will look like the sample shown above and will be 8.5" x 5.5". It is designed to look like a "short form" birth certificate. If this is not what you want DO NOT ORDER.

☑ Novelty Birth Certificate format

I understand my novelty birth certificate will be printed on 8.5" x 5.5" security paper and will look like the sample shown above (https://fs18.formsite.com/documentservicesllc/images/fake_birth_certificate__style_2.jpg).

Name of Hospital

Issuing Agency 🛈

Name of agency that issued the certificate (example: Arlen County Office of Vital Records)

Issuing agency name ONLY. If you list anything else on this line, such as "Certification" or "Certificate of Live Birth" - it will NOT be printed on your certificate.

Street address of the issuing agency

Street address ONLY. If you list anything else on this line, such as "Office of Vital Records" or "Certificate of Live Birth" - it will NOT be printed on your certificate.

City 🛈

State

Zip Code

Child's first name

Child's middle name

Child's last name

Hour child was born

Minute

AM/PM

Child's Birth Month

Date

Year

Child's sex

Child's city of birth

Child's state of birth

Mother's first name

Mother's middle name

Mother's last name 🛈

Mother's state of birth

Mother's country of birth

Do you want a Father's name listed on the birth certificate?

Father's first name

Father's middle name

Father's last name

Father's state of birth

Father's country of birth

☑ Father's information

I understand that my birth certificate will come with BLANK lines for the Father's name and the Father's birthplace

Birth Certificate signature lines

If you choose to have signatures applied to your document we will do so using names of our choosing, we will not take requests for specific names.

☑ Birth Certificate signature lines

I understand that my birth certificate will NOT have signatures on it.

Month Certificate was issued

Date

Year 🛈

This is the date that you requested a copy of the certificate, NOT the date that the certificate was filed with the State the child was born in. This date needs to be at least ONE WEEK after the child's date of birth but it does NOT have to be in the same year that the child was born. For example, the child could have been born in 1980 but you did not request a copy of the certificate until 2015. The security paper that we print our certificates on wasn't patented until the year 2000, so you cannot request an issued date before that year.

☑ Certificate Issued Date

I understand that if I select an issued date that is not at least one week AFTER the child's birth date, my order may be canceled.

Clerk's signature

If you choose to have a signature applied to your document we will do so using a name of our choosing, we will not take requests for a specific name.

☑ Birth Certificate clerk's signature

I understand that my birth certificate will NOT have a clerk's signature on it.

Certificate Number

Certificate Number 🛈

Embossed (imprinted) certificate seal

Would you like to purchase extra copies of your birth certificate?

Purchase extra copies of your birth certificate

Additional copies of my birth certificate @ $5 per copy

Shipping method

We do not offer digital copies by email or fax. If you need your order quickly please select one of our upgraded shipping methods.

Urgent and Critical orders placed after 9:00 am EST Monday - Friday may not ship until the next business day.

Business days are Monday through Friday and do not include weekends, holidays, or days that we are closed.

☑ Standard Shipping

I understand that orders with Standard shipping can take up to TWO WEEKS to be delivered.

Promo Code

Have you ordered from us before?

Order Total:

$0.00

Card type

We will ONLY ship to the billing address associated with your credit or debit card, NO exceptions.

Is this a prepaid or gift card?

To make an online or phone purchase, you will need to register your card. You can do this by either calling the issuing provider, or by visiting their website. This information should have been supplied to you when you received the card. It may also be printed on the back of the card.
When you make an online or phone purchase, the name, address, and phone number you use will need to be exactly the same as the information you provided when registering your card.
If the information you provide differs from what was provided when the card was registered, the transaction will be declined.
You can verify or update your information by visiting the card provider's Web site, or by contacting them using the toll-free number provided in your card materials.

15 digit card number 🛈

16 digit card number 🛈

Card Expiration Month

Card Expiration Year

CID-4 Code

CID Code

CVC Code

CVV Code

If your card is locked, please UNLOCK it and LEAVE it unlocked until we have charged your card. Please note that it may be several hours before we charge your card.

First Name

Last Name

Is the name on the credit card the same as one of the names on the birth certificate?

Credit card holder's relationship to the CHILD

The address you provide below must be an EXACT match to the address on your credit card or bank statement or your order WILL be refused.

Street Address 🛈

Did you include your apartment or unit number above?

City

State 🛈

Zip Code

Phone #

The email address you provide below MUST belong to the person paying for the order or your order will NOT be processed. If we cannot tell who the email belongs to your order will NOT be processed.

Email address

Re-enter Email address

☑ Acceptable Use Policy

I attest that I understand that the novelty birth certificate I am purchasing is sold and intended for novelty purposes only (such as a personal keepsake or family heirloom). I also attest that I will not use the novelty birth certificate for illegal purposes of ANY kind including but not limited to use in obtaining identification or use as identification. I also understand that using the novelty birth certificate for illegal purposes may result in serious legal consequences for me should I do so.

☑ Billing, Cancellations, and Refunds

I understand this charge will appear on my bank or credit card statement as "DOCUMENT SERVICES LLC". I understand that once my credit card has been charged, my order cannot be canceled. I understand that these are custom personalized documents and therefore cannot be returned. I understand that all sales are final and no refunds will be issued under any circumstance. I understand that if you make a mistake on my order, I will be sent a replacement order at no cost but I will not receive a refund. I understand if my order arrives damaged, I will be sent a replacement order at no cost but I will not receive a refund. I understand if my package is lost by the shipping carrier, I will be sent a replacement order at no cost, but I will not receive a refund. By submitting this order form, I acknowledge that I have been provided with and agreed to these policies prior to placing my order.

If we make a mistake on your order, we will replace it for FREE. If your order arrives damaged, we will replace it for FREE. If your order is lost by the shipping carrier, we will replace it for FREE.

☑ Credit Card Dispute Policy

I understand that if I initiate a credit card dispute (chargeback) against you, a copy of my order form, a copy of the document(s) I purchased, proof of delivery, and any other pertinent information that you have on file WILL be sent to my bank or credit card company to refute the dispute.

☑ Birth Certificate Specifications

I understand my novelty birth certificate will be printed on 8.5" x 11" ivory colored linen card stock. I understand I am not purchasing a replica document and that my birth certificate will be prepared in the format shown on your website and order form. I understand that you will not alter or modify your formats, fonts, or wording. I understand that if I elected to have computer generated or hand written signatures added to my certificate, the names you use will be made up names, they will NOT be the real names of any person affiliated with the hospital I provided on the order form. I understand that you do not provide email "proofs", PDF copies, faxed copies, or digital copies of any kind.

☑ Birth Certificate Specifications

I understand my novelty birth certificate will be printed on 8.5" x 5.5" security paper. I understand I am not purchasing a replica document and that my birth certificate will be prepared in the format shown on your website and order form. I understand that you will not alter or modify your formats, fonts, or wording. I understand that if I elected to have a conputer generated clerk's signature added to my certificate, the name you use will be a made up name, it will NOT be the real name of any person affiliated with the issuing agency that I provided or had you provide for me on the order form. I understand that you do not provide email "proofs", PDF copies, faxed copies, or digital copies of any kind.

☑ Hand Written Signatures

I understand that handwriting varies from person to person and no refunds or replacements will be given in the event that the signatures on the birth certificate I receive are not entirely legible or that they are not "pretty" enough.

☑ Shipping Policy

I understand that you will only ship to the credit card billing address, no exceptions. I understand that business days are Monday through Friday and do not include weekends, holidays, or days that you are closed. I understand that orders with Standard shipping and Rush shipping will be shipped within two (2) business days after my order has been paid for. I understand that orders with Urgent and Critical shipping will be shipped within one (1) business day after my order has been paid for. I understand that I will be sent a tracking email from Stamps.com or UPS within one (1) business day after my order has been shipped. I understand that it may take up to 24 hours for online tracking information to be updated after a tracking number is created. I understand that once the package is dropped off with the shipping carrier the vendor has no control over the delivery process and no refunds will be issued for late shipments caused by the shipping company. I understand that your Standard shipping service is USPS Ground Advantage. I understand that your Rush shipping service does not refer to any specific shipping service and that my order may be shipped by any method that ensures my order will be delivered in 3 to 6 business days from the date that I paid for my order. I understand that your Urgent shipping service does not refer to any specific shipping service and that my order may be shipped by any method that ensures my order will be delivered in 2 to 4 business days from the date that I paid for my order. I understand that your Critical shipping service does not refer to any specific shipping service and that my order may be shipped by any method that ensures my order will be delivered in 1 to 3 business days from the date that I paid for my order. I understand that orders with Urgent and Critical shipping that are placed after 9:00 am eastern time Monday through Friday may not ship until the next business day. I understand that if my shipment is returned to you because I provided you with an inaccurate address or because I refused or failed to take delivery of the package, I will not receive a refund and I will be required to pay the shipping fee again to have it resent to me.

☑ Terms and Conditions

I have read and agree to all Terms and Conditions listed at https://www.diplomasandtranscripts.com/terms-and-conditions.html and declare that I have checked the laws where I live and I am not prohibited from purchasing or possessing a novelty document. I understand that the novelty documents are not being issued by any school, hospital, state, or government agency and that the vendor is not a representative or licensee thereof. I understand that all documents sold on this site will have a label on the back side indicating that the document is for novelty purposes only. I understand that the novelty documents have no educational or legal value of any kind. I agree that I will not present any novelty document from this vendor as an item having value, credit or merit of any kind. I fully release the vendor and all persons associated with the sale of the novelty document(s) from any and all liability that may arise out of my placing an order.