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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______

WE RESERVE THE RIGHT TO REFUSE SERVICE TO ANYONE

** For Novelty purposes only: **


MARRIAGE CERTIFICATE PRICES AS FOLLOWS:

$60.00 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 AND YOUR CREDIT CARD:

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:***