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Please read carefully then follow instructions on form for Novelty Baptism Certificate:

To order a Baptism Certificate PRINT THIS PAGE on Your Printer First, fill in the Questions, Sign, and mail complete form with CASH or MONEY ORDER IN US DOLLARS, MONEY ORDER MUST BE PAYABLE ON A US BANK to Billy Moore at P.O.Box 183 - Hillview, Kentucky 40129-0183 . Allow 5-10 working days for return. Don't forget to add cost of mailing if You want any special return mailing. You have 15 days to return it in the same condition as received for a full refund if not completely satisfied, less postage cost.

Important: PLEASE print or type where I may read it, there will be a charge for any certificate reworked due to errors caused by not being able to read the order form!

"ORDER"FORM"BAPTISM CERTIFICATE"

Note: Please fill in the following information exactly as wanted printed on certificate!

TO BE COMPLETED FOR BAPTISM CERTIFICATE:

1. NAME ____________________________________________________________________

2. MOTHERS NAME _________________________________________________________ AGE __________

3. FATHERS NAME _________________________________________________________ AGE __________

4. PLACE OF BIRTH CITY/STATE/COUNTRY _______________________________________________________________________

5. PLACE OF RESIDENT WHEN BAPTISED CITY/STATE/COUNTRY ___________________________________________________

6. LOCATION WHERE BAPTIZED CITY/STATE/COUNTRY____________________________________________________________

7. SPONSOR NO. ONE NAME (MAY BE COMPUTER GENERATED CG) __________________________________________________________ (CG) Y_____ N ______

8. SPONSOR NO. TWO NAME (MAY BE COMPUTER GENERATED CG) __________________________________________________________ (CG) Y_____ N______

9. NAME OF MINISTER (MAY BE COMPUTER GENERATED CG) ________________________________________________________________ (CG) Y_____N______

10. DATE OF BAPTISM ___________________________________________________________________________________________

11. NAME OF CHURCH (AS WELL AS TYPE BAPTIST, CATHOLIC, ETC.) _______________________________________________

12. NAME AND ADDRESS OF CHURCH IF KNOWN OR WANTED _____________________________________________________

13. DATE BAPTISM CERTIFICATE ISSUED __________________________________________________________________________

14. DATE OF BIRTH _______________________________________________________________

IF YOU NEED MORE LINES PLEASE PRINT OUT ANOTHER FORM:


"MAILING INFORMATION"

Within the USA Mail to: Name ____________________________________________________________________

Address: Street and Number ______________________________________________________________________

City: _________________________________________________, State: ____________________Zip: __________

E-Mail Address: (THIS E-MAIL ADDRESS WILL ONLY BE USED TO CONTACT YOU IF WE HAVE QUESTIONS REGARDING THIS ORDER, OTHER WISE WE WILL BE REQUIRED TO RETURN THE ORDER INCOMPLETE IF PROBLEMS ARISE)

_________________________________________________@_________________________________________

Outside the USA Mail to: Name____________________________________________________________________

1st Address______________________________ 2nd Address___________________________________________

City/Town_______________________________ Zip/Country Code___________________ Country____________________________

Telephone ( _____ ) ____________________________

Fax ( _____ )_________________________

E-mail____________________________________________@___________________________________________.

** For Novelty purposes only **


BAPTISM CERTIFICATE PRICES AS FOLLOWS:

$50.00 PER CERTIFICATE:

PLEASE LIST PAYMENT AMOUNTS ENCLOSED WITH ORDER BELOW:
$ ________ COST OF CERTIFICATES _________ NUMBER OF CERTIFICATES THIS ORDER:
$ ________ OTHER PAYMENT, PLEASE STATE ________________________________________:
$ ________ SUB TOTAL AMOUNT ENCLOSE WITH ORDER:
$ ________ SUB TOTAL AMOUNT MINUS 20% DISCOUNT FOR CASH PAYMENT
** DO NOT INCLUDE POSTAGE IN THIS DISCOUNT OR IF PAYMENT IS MADE WITH MONEY ORDER ** CASH CURRENCY ONLY **!:

$________ NOW ADD POSTAGE COST TO THE SUB TOTAL ABOVE:
$________ FULL AMOUNT ENCLOSED WITH THIS ORDER:

NOTE: MULTIPLE ORDERS WILL BE MAIL TOGETHER IN ONE ENVELOPE UNLESS OTHERWISE SPECIFIED WHEN ORDERING


YOU MAY NOW PAY USING PAYPAL:
YOU WILL STILL NEED TO COMPLETE ORDER FORM AND SEND BY E-MAIL, LAND MAIL, OR FAX TO 1-502-955-6790
PLEASE PAY AMOUNT LISTED AS FULL AMOUNT ENCLOSED WITH ORDER AS LISTED ABOVE:

Make payments with PayPal - it's fast, free and secure!

**** NOTE ORDERS WILL ONLY BE SHIPPED TO CONFIRMED PAYPAL ADDRESS WHEN PAYING WITH PAYPAL!! ***


LAST UP DATED: 03-17-2002

*** END OF APPLICATION FORM:***