Please fill out and then print the following form. Then, make a copy of your Driver's License or your state issued identification card (if available) and fax both to:
The box that says V-Code means the last three numbers on the back of your Visa/Mastercard in the signature box.
Please type in all caps below.
Fees: State Fee $25.00-$60.00 plus our fee of $45.00 for regular processing
|Please charge me the total service fee of $137 for passport and birth certificate processing||*please read the Passport & Birth Certificate section before clicking yes|
Emergency Birth Certificate Processing (additional fee of $25.00)
CALIFORNIA ORDERS NOTE THE IMPORTANT INFORMATION BELOW: Please be aware that California birth certificates are taking a long time to process. On 12-1-06 the Department of Vital Records stopped accepting walk in birth certificate requests from the general public because of financial problems. We are able to submit requests to their office and we are given special treatment, our average process times are 6-7 (4-5 Emergency) business days. Until further notice these process times will be in effect.
4-6 Day California walkthrough service, ALL fees included $136.00
If you selected 'yes,' click HERE to download the additional forms for California.
Credit Card Number:
Expires: Choose one:
Name on Credit Card: V-Code (required)
Credit Card Billing Address:
City State Zip
Social Securtiy Number:
Certificate Holder's Name at Birth (or adopted name):
Mother's Full Maiden Name:
Birth Date: State of Birth
County of Birth: City of Birth:
Social Securtiy Number:
Were parent's married at time of birth?
Adopted or Legal Name Change
If adopted use adopted name and adopted parents' names, Pre-adopted certificates are unavailable
Hospital: Sex: Number of Copies:
Ship Method: Express Courier Date of Departure:
Ship-To Address (no P.O. Boxes)
City: State: Zip:
Daytime Telephone: ( ) - - - Extension
Alternative Telephone Number:( ) - -
I authorize Texas Tower to obtain my birth certificate for me.
I understand that Texas Tower is not responsible for any service performed by any overnight courier service.
All Sales Final
** By signing this form I agree that there are no refunds by Texas Tower.
Please fax a copy of your driver's license (if available--for minors please fax a copy of the parents' license)
Please insert any special instructions below (if your shipping address is a business address, please insert this
If you will not be at your shipping address to sign for the overnight courier package when it arrives
then you will need to leave a signed letter on your door requesting that the package be left wherever