Birth Certificate Order Form

Birth Certificate Order Form
Please accurately fill out all necessary information below
Fax w/ copy of photo id. to 416-962-2968
Click here to go to main page
NOTE : THIS FORM IS NOT SENT ONLINE. IT MUST BE FAXED OR MAILED
.

MAILING ADDRESS (Please fill out all including postal code)

Name:
Mailing Address:
Address Con't:
City & Province: Postal Code:
Daytime Telephone: E-mail:
Relationship to Person Named:Reason Certificate is Required

Signature:___________________________________________________ Date:

BIRTH CERTIFICATE (Please fill out all to order birth certificate)

Certificate Holder Name:
	First Name	Middle Name	Last Name

Place of Birth:
	City	Province

Certificate Holder Birth Date

Sex:

Father's Full Name
	First Name	Middle Name	Last Name

Birthplace:
	City	Province / State	Country
Maiden Name of Mother:
	First Name	Middle Name	Last Name
Birthplace:
	City	Province / State	Country

Name on Credit Card:

Credit Card Number*: Expires

Signature:__________________________________ Date: Certificate Requested
I certify that all of the above information is true and correct to the best of my knowledge
and I have a legal claim to the above document.
I authorize the operators of Canadian Birth Certificate. Com or their representative to obtain my certificate for me.
Please note any special instructions for order below.
ALL RUSH PROCESSING REQUIRES " PROOF OF URGENCY "

We thank you for your business ! Please contact us anytime with questions or concerns.

* FOR RUSH DELIVERIES: You must list a physical street address (no APO's, FPO's, or P.O. Boxes)
ALL RUSH PROCESSING REQUIRES " PROOF OF URGENCY "

Fax to: 416-962-2968
*If you wish to charge your shipment on a Discover or American Express, put all your
credit card information in the special instructions section.

Choose One:Rush Delivery requires proof of urgency. Number of Certificates Requested
All Sales Final, No Debit Cards Accepted.Process times may vary based on workload of state agencies.
I understand that Canadian Birth Certiificate.Com is not responsible for any service
performed by any overnight courier service or goverment agency. I understand that Canadian Birth Certificate. Com can not control
the procees time by individual agencies.This website is operated by US Vital Documents in Austin Texas.

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