Birth & Death Certificate Order Form

Birth & Death Certificate Order Form

Fill out form or contact 1-866-755-2393
Welcome to our birth and death certificate ordering service! We are pleased to offer delivery of these vital documents to your doorstep. Deliveries are scheduled for Tuesdays and Thursdays. For urgent needs, expedited services are available for an additional fee. Expedited Orders received by 12:00 pm will be delivered on the same day. Expedited orders received after 12:00 pm will be delivered the next day. Please fill out the form below to place your order.

This service is offered to residents of Cuyahoga, Geauga, Lake, Lorain, Medina, Portage, and Summit county. Contact 1-866-755-2393 if you live outside of these counties to see if we still can assist you.

Fees: $75 ($25 each for all additional copies)

Expedited: $125 ($25 for all additional copies)
Type of Certificate:

Birth CertificateDeath Certificate
All fields must be completed to receive certificate. If there is no middle name write unknown in field. If father is unknown, please enter unknown in field.
Full Name on Birth OR Death Certificate *

First NameMiddle NameLast NameSuffix
If name was changed since birth, indicate new name:(i.e. adoption, legal name change, paternity,etc)

First NameMiddle NameLast NameSuffix
Date of Birth Or Date of Death*

MonthDayYear
Date
City and County Where Event Occurred *
Mother Full Name*

First NameMiddle NameLast Name
Father Full Name*

First NameMiddle NameLast NameSuffix
Your Name*

First NameLast Name
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
Delivery Location*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Please choose time to be hand delivered . Deliveries may be made any time after the time chosen.

Hour Minutes

AM/PM Option
If not available and would like the document to left at location. Please specify instructions below.

Certificate Purchase*

Regular Delivery

$75.00 Quantity

Expedited Delivery

$125.00 Quantity

Additional Copies

$25.00 Quantity

Total

$0.00

Payment Details
First Name	Last Name
Credit Card Number	Security Code
Card Expiration

Should be Empty: