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| We are a private service that expedites the ordering of your Canadian Birth Certificate. You will need to fill out this form along with the Yukon application and fax both to us at 512-331-8230 Name of Certificate Holder: ________________________________________________ Date of Birth ( Marriage / Death ): ___________________________________________________________
If no proof is provided your application will not be rushed, Date Needed by: _____________________________________________ Daytime Phone # ____________________________________________ Email Address: ______________________________________________ Ship to Address: ____________________________________________________________ _____________________________________________________________ _____________________________________________________________ ______________________________________________________________ I give my permission to process this application and have my credit card charged for both the Canadian Birth Certificate .Com service fee and all fees charged by Yukon Vital Statistics. I authorize Brian Wright or any of his agents, as my legal represenative in this matter. _____________________________________________________________ Signature We accept Visa or Mastercard, Canadiian Birth Certificate. Com / US Vital Documents or any of its agents are not responsible for mistakes or delays from passport offices, consulates, embassies travel agents, overnight courier services, or vital records departments. I understand that the passport office or above agencies can delay or deny passports, visas or birth certificates at their own disgression. |