Custom Birth Certificate

Please fill out and attach to order form

Note: Artist is not responsible for errors resulting from illegible copy.

Date of Order ____/____/____

Certificate Item # or Title________________________________________

Size of Artwork ____X____

Paper Color (Select One) ____Black ____Burgundy ____ Blue

Baby's Name__________________________________________________

(Is it acceptable to use middle initial if space is limited? ___Yes ___No

Date of Birth: Month___________________Day___________Year_____________

Time_____________ (Circle one) AM PM

Weight_____________lbs. __________ozs.

Length_____________ inches

City (Optional)__________________________________________________

State (Optional)__________________________________________________

Parents________________________________________________

(Is it acceptable to use middle initial if space is limited? ___Yes ___No

Special Instructions:

All artwork is an original and may vary some what from original shown, each piece is unique, but similar.

Please allow 4 to 6 weeks for completion and delivery, if needed before allotted time, please add $15.00 rush charge to order.

Order Information
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