Please read carefully then follow instructions on form for THEOLOGY CERTIFICATE:
To order a THEOLOGY 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 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!
"ORDER"FORM" TO BE COMPLETED FOR THEOLOGY CERTIFICATE:
NOTE: PLEASE FILL IN THE FOLLOWING INFORMATION EXACTLY AS WANTED PRINTED ON THE CERTIFICATE!
1. NAME OF INSTITUTION:__________________________________________________
2. STUDENT NAME COMPLETE: ______________________________________________
3. DATE OF DEGREE:(MM/DD/YYYY) __________________________________________
4. TITLE OF DEGREE: _____________________ MAJOR COURSE __________________
5. 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 ________________________________________
6. SIGNATURE LASER PRINTED OR COMPUTER GENERATED (CHECK ONE) COMPUTER GENERATED CHECK HERE _____
OR IF YOU WISH TO SIGN IT YOURSELF CHECK HERE ______ !
7. 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 "
8. For special instructions attach separate paper. For best results send an EXAMPLE of Certificate.
9. Blank Transcripts except for Name, Logos and embossed REGISTRAR SEAL may be ordered at
$60.00 per page, Transcript 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 additional per 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 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 university, college, or school
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
WE RESERVE THE RIGHT TO REFUSE SERVICE TO ANYONE
THEOLOGY CERTIFICATE PRICES AS FOLLOWS:
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 special shipping and handling of larger size item, 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
IF YOU NEED MORE LINES PLEASE ATTACH ANOTHER PAPER TO ORDER FORM WHEN MAILING NOTING SPECIAL
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_____________________________________________________
City/Town_______________________________ Zip/Country Code___________________
Telephone ( _____ ) ____________________________
Fax ( _____ )_________________________
** For Novelty purposes only: **
EXPRESS MAILING INSTRUCTIONS PLEASE READ IMPORANT !!
NOTE: Check appropriate box for mailing. Please state by placing a check mark if you wish to
WAIVER SIGNATURE when receiving EXPRESS MAIL! _______ Yes I wish to WAIVER SIGNATURE on my return mail, **NOTE**
you will have to sign for document if this box is not checked! PLEASE
WAIVER SIGNATURE WHEN SENDING EXPRESS MAIL TO ME, IF NOT IT COULD DELAY YOUR ORDER AS MUCH AS THREE DAYS!
LAST UP DATED: 01-26-2012
*** END OF APPLICATION FORM:***