Please read carefully then follow instructions on form for High School / Home
School Diploma, and GED:
To order a certificate PRINT THIS PAGE on Your Printer First, fill in the Questions, Sign, and
mail complete form with payment in CASH or MONEY ORDER IN US DOLLARS, MONEY ORDER MUST BE PAYABLE ON A US BANK
to D. MOORE at P.O.BOX 183 - HILLVIEW, KY 40129-0183 . Allow 5-10 working days for return. Don't forget to add
cost of mailing if You want any special return mailing. If not completely satisfied, e-mail immediately upon receipt
of order that you were not satisfied and are requesting a refund, You then have 2 days to return it in the same
condition as received for a full refund less postage cost and $18.00 for
special handling if ordering 10 x 13 or 11 x 14 certificate. Your return Post Mark will verify when you place it
in the return mail, this is to prevent customers using the documents for their needs and then requesting a refund.
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!
View Sample Home School Diploma... HERE
View Sample High School Diploma and G.E.D. Certificate... HERE
View Sample of Two High School Diploma Formats... HERE
"THIS FORM IS FOR HIGH SCHOOL /HOME SCHOOL DIPLOMA AND GED'S " ORDERS
ONLY"COMPLETE INFORMATION BELOW"
Note: Please fill in the following information exactly as wanted printed on certificate!
- Name of School:__________________________________________________
- Type of School please check one: High School ______ GED _______ or Home School ________
- Location Diploma was obtained: Location (City/County): ______________________________________
- Complete name of person receiving the diploma ______________________________________________
- Date Diploma was given (example) May 30, 1990 ____________________________
or mm/dd/yyyy ___________________________
- List titles of signatures wanted at bottom of certificate (examples)Chancellor, Provost,
President, Dean of Students or other PLEASE ADVISE BELOW
(1st)Title ___________________________ (2nd)Title __________________________________
for additional signature/title, please state _______________________________________________.
(NOTE PLEASE) I need to know the TITLE of the person signing the certificate, not the name of the person signing!
If wanting specific names to these titles in the form of a computer generated signature please indicate the name
of the person below!
(1st) Title persons name _________________________________________________
(2nd) Title persons name _________________________________________________
(3rd) Title persons name if required ________________________________________
(4th) Title persons name if required ________________________________________
SIGNATURE LASER PRINTED OR COMPUTER GENERATED (CHECK ONE) COMPUTER GENERATED CHECK HERE _____
OR IF YOU WISH TO SIGN IT YOURSELF CHECK HERE ______ !
- Seal type and placement: please advise if You want a (RAISED EMBOSSED SEAL at $6.00 additional
cost with your schools name and a logo WHEN AVAILABLE) in GOLD, BLACK. Indicate your choice for RAISED SEAL by
checking here and color desired ______ .Location for placement of seal. MIDDLE, RIGHT or LEFT side at bottom of
certificate, or other. Your choice for location of Seal _______________. If other than " M " R "
L " indicate where on certificate ___________________________.
- If you do not want the special RAISED SEAL above at $6.00 additional cost with your schools
name and logo when available, you may select from one of these foil seals at NO ADDITIONAL COST ,view Seals by
selecting... HERE ... SEAL #
_______ List Location for placement of seal MIDDLE, RIGHT or LEFT ______ side at bottom of certificate, If wanting
a Printed Seal at no additional charge and check here _____ .Your choice for location of Seal ____ If other than
" M " R " L "
- Certificate Format: All $60.00 certificates are 8.5 x 11 Printed Horizontal (WIDE) unless
other wise specified by checking this BOX ____ and indicating size and format below ( NOTE) Sizes 10 x 13 or 11
x 14 are available for ($102.00), Plus additional($18.00) for shipping and handling of larger size, please state
size if other than 8.5 x 11 here _____ Vert. (LONG) x ______ Horz. (WIDE:), smaller sizes available (SAMPLE) 6
x 8 for the same $60.00 charge, you may also want a laminated wallet size for $30.00 additional cost with any certificate
order and check here ____.
- Also now available for all 8.5" x 11" certificates a Padded Vinyl Folder in Blue
or Green color at $30.00, or a Keepsake Folder in sturdy heavy weight Blue paper with satin corners only $12.00
additional cost, please check here and indicate preference also at bottom of form.________. As of 7-10-2002 I will
have the Padded Vinyl Folders in Blue or Green for 6" x 8" certificates at $30.00 .View Sample Here for 8.5" x 11" Folders
** PLEASE VIEW SAMPLES OF FORMATS BELOW BEFORE SELECTING **
HERE Vertical Format
HERE Horizontal Format
- For special instructions attach separate paper. For best results send an EXAMPLE of Certificate.
- Blank Transcripts except for Name, Logos and embossed REGISTRAR SEAL for University or other
non-existing school may be ordered at $60.00 per page (BLANK), with COURSE DESCRIPTION and GRADES $102.00 first
page and $48.00 per additional page with the order of any Certificate or $180.00 first page and $102.00 per additional
page without Certificate Order.
DECLARATION (to be read by ALL prospective clients and customers). If you intend to order a
certificate, you are reminded to read and sign the following notice prior to posting any orders. In consideration
of my order I hereby release and forever discharge Home School Diplomas, it's agents, instrumentalities, and representatives
of all liabilities, claims, damages or costs which I may have against them arising out of, or in any way connected
with my order and receipt of such certificate and/or any other product from Home School Diplomas. I understand
this waiver includes claims based on negligence, action, or inaction of myself and of any other parties. By affixing
my signature I hereby agree to release all persons affiliated with homeschs from all damages that may arise from
fraudulent, misrepresentative, and illegal use of certificates and/or any product provided by Home School Diplomas.
While every care is taken to ensure the accuracy and integrity of the information pertaining to products provided
by Home School Diplomas, the parties involved in the design of this website take absolutely no responsibility whatsoever
for any damages or liabilities arising out of the unlawful misuse of such products. Please note that orders NOT
accompanied by the following completed form with the appropriate signatures and payment, including miscellaneous
incidental mailing and handling costs in the form of CASH or MONEY ORDER in USD will either be returned or result
to delay of processing. I the undersigned understand and confirm that this certificate was made for me to my specification
as a novelty item. I will not misrepresent it as an official document from said school, church, state or local
agency in any fraudulent manner. With my signature I confirm and accept full responsibility for the contents of
and for any use or misuse of this diploma after receiving it. By signing below I agree with all the aforementioned
WE RESERVE THE RIGHT TO REFUSE SERVICE TO ANYONE
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 ( _____ )_________________________
** For Novelty purposes only: **
EXPRESS MAILING INSTRUCTIONS PLEASE READ IMPORTANT
- Please add $20.00 for US Postal Express Mailing of 8.5 x 11 order within the USA. _____
- Please add $ 6.00 for US Postal Priority Mailing within the USA. _____
- Please add $ 5.00 for Plain Heavy Weight Kraft Envelope Mailing within the USA. _____
- Please add $40.00 for Regular US Postal Service International Mail and handling. ______
- Add $52.00 - $100.00 depending on country destination for US Postal Service International Express Mail and handling. ______
- * NOTE * FedEx states that it no longer accepts P.O. Box address from sender or receiver
THEREFORE FedEx IS NO LONGER AN OPTION!
- * NOTE * DHL states that it no longer accepts P.O. Box address from sender or receiver
THEREFORE DHL IS NO LONGER AN OPTION!
- * NOTE * UPS states that it no longer accepts P.O. Box address from sender or receiver
THEREFORE UPS IS NO LONGER AN OPTION!
- Provide phone number where you may be reached for delivery. Please include COUNTRY CODE, AREA
CODE, and TELEPHONE NUMBER to assure prompt delivery. ______________________________. I assure you that this telephone
information will only be used for this reason.
PRICES FOR CERTIFICATES:
$60.00 FOR 8.5 X 11 CERTIFICATE OR SMALLER
$102.00 FOR 10 X 13 OR 11 X 14
PLEASE LIST PAYMENT AMOUNTS ENCLOSED WITH ORDER BELOW:
$ ________ COST OF CERTIFICATES _________ NUMBER OF CERTIFICATES THIS ORDER:
$ ________ ADD $30.00 FOR 10 X 13 OR 11 X 14 FOR SPECIAL HANDLING AND POSTAGE:
$ ________ LAMINATED WALLET SIZE $30.00 EACH WITH ORDER OF CERTIFICATE
$ ________ PADDED VINYL FOLDER $30.00 EACH, FOR 8.5" X 11" CERTIFICATE ___ OR 6" x 8" CERTIFICATE
$ ________ KEEPSAKE FOLDER $12.00 EACH, FOR 8.5 X 11 CERTIFICATE ONLY:
$ ________ $6.00 EACH FOR RAISED EMBOSSED SEAL:
$ ________ 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 **ONLY CASH CURRENCY ONLY IN US DOLLARS **!
$________ NOW ADD POSTAGE COST TO THE SUB TOTAL ABOVE:
$________ FULL AMOUNT ENCLOSED WITH THIS ORDER:
$________ CHECK HERE IF USING COUPON AND STATE AMOUNT OF COUPON
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:
**** NOTE ORDERS WILL ONLY BE SHIPPED TO CONFIRMED PAYPAL ADDRESS WHEN PAYING WITH PAYPAL!!
LAST UP DATED: 01-26-2012
*** END OF APPLICATION FORM:***