Please read carefully then follow instructions on form for Novelty Marriage Certificate:
To order a Marriage 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 D. 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. 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. 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!
"ORDER"FORM"MARRIAGE CERTIFICATE"
Note: Please fill in the following information exactly as wanted printed on certificate!
TO BE COMPLETED FOR MARRIAGE CERTIFICATE:
1. GROOMS NAME _________________________________________________________ AGE ____ RACE _____________________
2. BRIDES NAME ___________________________________________________________ AGE ____ RACE _____________________
3. GROOMS PLACE OF BIRTH CITY/COUNTY/STATE/COUNTRY_____________________________________________________
________________________________________________________________________________________________________________
4. BRIDES PLACE OF BIRTH CITY/COUNTY/STATE/COUNTRY ______________________________________________________
_______________________________________________________________________________________________________________
5. DATE OF MARRIAGE mm/dd/yyyy ____________________________________________________________
6. LOCATION WHERE UNITED CITY/STATE/COUNTRY_____________________________________________________________
_______________________________________________________________________________________________________________
7. WITNESS NO. ONES NAME IF WANTED COMPUTER GENERATED SIGNATURE CHECK HERE _______ OR IF YOU
WANT
A SPECFIC NAME INDICATE NAME HERE _________________________________________________________________________
8. WITNESS NO. TWOS NAME IF WANTED COMPUTER GENERATED SIGNATURE CHECK HERE _______ OR IF YOU
WANT A SPECFIC NAME INDICATE NAME HERE ___________________________________________________________________
9. NAME OF MINISTER IF WANTED COMPUTER GENERATED SIGNATURE CHECK HERE _______ OR IF YOU WANT
A SPECFIC NAME INDICATE NAME HERE ______________________________________________________________________
SPECFIC NAMES ABOVE WILL BE LASER PRINTED ON CERTIFICATE, IF THIS IS NOT WANTED YOU MAY ELECT TO LEAVE NAME OFF
AND SIGN THE CERTIFICATE YOURSELF, IF THIS IS YOUR ELECTION PLEASE INDIACATE BY CHECKING HERE _________ I WILL
SIGN MYSELF.
10. SPECIAL NOTES OR WORDING YOU MIGHT WANT TO ADD TO THE DOCUMENT:
________________________________________________________________________________________________________
IF YOU NEED MORE LINES PLEASE ATTACH ANOTHER PAPER TO ORDER FORM WHEN MAILING NOTING SPECIAL INSTRUCTIONS:
"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)
E-mail_______________@_______________________________
Outside the USA Mail to: Name___________________________________________________________
1st Address______________________________ 2nd Address_________________________________
City/Town____________________________ Zip/Country Code_________Country_________________
Telephone ( _____ ) ____________________________
Fax ( _____ )_________________________
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 Home School Diplomas 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 U.S. Money Order or Cash 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 state, local
or other 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 certificate or degree after receiving it. By signing below I agree with all
the aforementioned conditions.
Signature__________________________________DATE____/_____/ 20______