Certified Birth Certificate Request

This online form is encrypted and 100% secure. You will need to fill out this form completely. At the bottom of the form there is a continue button to transmit this information to our office. You will get an emailed sales receipt from our office. If there is a problem with your order we will call and/or email you. Your birth certificate will be delivered by FEDEX/UPS or US Mail whichever service you select on the order form below.

Birth Certificate Information
*Certificate Holder's Birth Date:
*Certificate Holder's Name: (Birth Name or Adopted Name)
*Father's Name:
*Mother's Maiden Name:
*Mother's Current Name:
*Adopted or Legal Name Change excluding marriage
We cannot obtain birth certificates for Connecticut, Iowa, New Mexico, Hawaii, Rhode Island, Florida, Indiana or Wisconsin.
*State of Birth: *Processing Time:
*City of Birth: *County of Birth:
Hospital: *Sex: Number of Copies:
*Reason for Request
*Person making this Request:
*Person making this request Date of Birth
*Person making this request Social Security # (numbers and dashes only)
*Person Making this Request Relationship to the Birth Certificate Holder
Shipping
*Ship to Name:
***Ship Address:
*City:
*State:
*Zip:
Ship to Address:
  • No P.O. Boxes for overnight shipping (Fedex/UPS).
  • Must match credit card billing address if you were born in KS, ME, NH, NJ, NC, NY & PA.
*Daytime Phone:
Other Phone:
Fax:

Please include a valid email address as this is the way we send your receipt and contact you if there is a problem.

File Upload

If your state requires extra documents you can take a picture of them with your cell phone and upload below or attach them from your computer.

What kind of device did you make your order on?
Billing
*Name on Card:
*Card Type:
*Card Number:
  (Visa, M/C and Discover only)
*Expiration:
*Billing Address:
*City:
*State:
*Zip:
*V-Code: (Last 3 numbers on the back of the card in the signature box)
(Required for birth certificates from KS, ME, NH, NJ, NC, NY & PA)
Fees
**State Fee: $11-$69 (Most are $25-$40); Plus Our Regular Fee: $49

Please charge me "total service fee $170" for passport and birth certificate processing

Lifetime birth certificate & passport processing additional $99 (government/state fees excluded)

Authorization
* I authorize USBirthcertificate.Com to be my legal representative and to obtain or order my birth certificate for me. USB.com will charge your credit card our fee upon receiving your request. I understand Usbirthcertificate.com is a private expediting service and I am hiring them to expedite my birth certificate order. I understand there is a state fee and Usbirthcertificate.com's fee. By submitting the form above you agree to these terms.

By clicking the submit button below you are sending your information electronically to our office so we can process your order. Once you click the button below your order will be processed by our office and cannot be cancelled. By clicking the button below you agree to these terms and the terms above.
Transaction Processing

ABOUT TRUST ONLINE

Please check the box in the authorization section above to enable the Continue button.

Once you submit your information to our office, if there is a problem we will call you.

* Required Information
** 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 if choosing overnight shipping.

Our voice number is 888-629-2016. All Sales Final.

Someone must be available to sign for the Federal Express/UPS. If no one is there, Fedex/UPS 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, it's a 2 step process to get your birth certificate and passport. Please contact us if the certificate does not arrive by the stated process time.

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.

Usbirthcertificate.com
Attn: Mail in Dept.
2600 South Gessner Rd. Ste 200
Houston, Texas 77063