EBirthCertificatePassports.com
You will need to fill out the form below and hit the print button on your browser. Then make a copy of your driver’s license or your state issued identification card enlarge 200% and fax both to us at 281-416-9554. You will get an emailed sales receipt within 2 business days, your order will start processing immediately after you fax it to us, if there is a problem with your order we will call you. Your birth certificate will be delivered by an overnight courier service, average delivery times are listed here. We cannot obtain birth certificates for Connecticut, Iowa, New Mexico or Hawaii.
PLEASE USE CAPITAL LETTERS ON THE FORM BELOW
Fees: State Fee: $22.00-69.00 (Most are $35-$40) Plus Our Fee: $59.00
Please charge me "total eBCPS service fee $175" for passport & birth certificate processing
Emergency Birth Certificate Processing (additional fee $25.00)
2-6 Day California walkthrough service, ALL fees included $167.00
Certified Birth Certificate Request
Credit Card Number:
Expires
Person's Name on Credit Card:
Credit Card Billing Address:
City:
Zip:
State:
Certificate Holders Name at Birth ( or adopted name):
First) (Middle) (Last)
Fathers Name:
First) (Middle) (Last)
Mothers Name:
First) (Middle) (Last)
Certificate holders Birth Date:
State of Birth:
County of Birth :
City of birth:
Adopted or Legal Name Change excluding marriage
If adopted use adopted name and adopted parents names, Pre-adopted certificates are unavailable.
Hospital Name:
Sex:
Number of copies:
Person making this request Date of Birth:
Person making this request Social Security # (REQUIRED)
Ship Method: Express Courier Date of Travel ( if applicable ):
Ship to Name:
Ship to Address:***( No P.O. Boxes)
City:
State:
Zip:
Daytime Telephone #
Extension:
Alternate Telephone #
Extension:
Email (REQUIRED):
Signature:____________________________________________Date
I authorize eBirthCertificatePassports.Com to be my legal representative and to obtain my birth certificate for me. eBCPS will charge your credit card our fee upon receiving your request even if the information is incomplete, the state of birth will charge your credit card seperately in some cases. eBCPS will email a receipt confirming that we have received your request within 2 business days. Please contact us if the certificate does not arrive by the stated process time. The lifetime birth certificate & passport processing service fee is non refundable and can only be used for the person named on the birth certificate request. There are no refunds of eBirthCertificatePassports.Com's services fees for any reason. I understand eBirthCertificatePassports.Com is a private expediting service and I am hiring them to expedite my birth certificate order. By signing the form above you agree to these terms.
Our voice number is 888-629-0084. All Sales Final... Due to the expedited nature of our service we do not cancel orders after they are placed.
I understand that ebirthcertificatepasports.com is not responsible for any service performed by any overnight courier service or government agency.
I understand that ebirthcertificatepassports.com can not control the process time by Individual state agencies. Process times may vary based on workload of state agencies.
* State Fees may appear on your credit card asVCN NETWORK, or VCN then the state name or as Bureau of Vital Statistics***You must list a physical street address (No APO's , FPO's or PO Boxes) where someone can sign for the certificate
•YOU MUST ALSO FAX A COPY OF YOUR DRIVERS LICENSE
Please lighten & enlarge 200% the COPY of your drivers license before faxing.
NO scanned images please.
• A parent must request birth certificates for minor children.
• We can not process this request without a signature.
Please sign this form in two places before faxing.
***You must list a physical street address (No APO's , FPO's or PO Boxes) where someone can sign for the certificate
Credit Card Orders....
Is the credit card in your name?
If NO...please also fax photo ID of certificate holder & credit card holder. Have credit card holder sign authorization below & certificate holder above.
If YES... please sign the order form above & authorization below & fax both pages with a photo ID.
Print name of the credit card holder: _______________________________________
Signature of credit card holder: ___________________________________
Date: ___________________________________
I authorize to charge my credit card for the birth certificate request of ____________________________________________________________________
(certificate holder name at birth)
by eBirth Certificate Passport
Credit Card Billing Address and phone number if different from shipping address:
**( if left blank and your shipping address does not match your billing address...your order will not be processed)
Print Address : ____________________________ State : ____________ Zip: _________
Phone : _______________________________
Please fax both pages 1-2 of this order form and photo ID of both the certificate holder (if not a minor) and the credit card holder (if different from certificate holder).
Someone must be available to sign for the Federal Express. If no one is there, Fedex will leave a note on the door (with a tracking number) to let you know that they have tried to deliver your package. You will need to follow the instructions on the door tag to coordinate delivery of your package.
If you have ordered the passport package please read and follow the instructions on our passport
section to be able to complete your passport application once your birth certificate arrives in your hands.
We can not process this request without a signature. Please sign before faxing.
CALIFORNIA BIRTH CERTIFICATE ORDERS ONLY we need a good fax number for you
Your privacy is important to us.Click here to read our privacy statement.
If you do not have access to a fax machine or would prefer to mail this order form to our office, please use the address below. If you mail this form and are paying with a money order please call our office so we can inform you of the total for your order.
eBirthCertificatePassports.com
Attn: Mail in Dept.
1685 S. Colorado Unit S.
PMB 198
Denver, CO 80222
