Thank You for your purchase.

To insure that everything on your order is correct,

Please Complete This Form


Transaction ID #:
(This is the number from the credit card transaction, Western Union MTCN, or Money Order Number)

Due to the frequency of names that can belong to either gender we ask you to indicate your gender here. Male Female

Complete for 1st Degree

Institution:

Name Exactly as you want it on your Diploma:

(Include periods, hyphens, or any punctuation necessary to your name. Capitalize only the first letter of each of your names.)

Degree:
Discipline:

(
If you are approved for a Discipline not listed, please select Other and write the discipline in the Additional Comments section below)

Graduation Date:
(If you are approved for a Graduation Date previous to those listed, please select Other and write the date in the Additional Comments section below)

Complete Items in box below if this is a Combination Order Only

Complete for 2nd Degree

Institution:

Name Exactly as you want it on your Diploma:

Degree:
Discipline:

Graduation Date:

Complete for 3rd Degree

Institution:

Name Exactly as you want it on your Diploma:

Degree:
Discipline:

Graduation Date:

By checking the box below this sentence I understand and agree to all points and terms of the Terms of Use Agreement

I have read and understand the Terms of Use Agreement and I am in full Agreement

Click here to view the Terms of Use Agreement


Your Name: Your Email:

Telephone: Time Zone:

Make A Shipping Label
(This is where your graduation packet will be sent)

In the 4 boxes below place your name, address, city, state, and postal code exactly as it appears on all mail you receive. If your mail only uses 3 lines, then only use 3 of the lines below.
If you used a credit card to make payment, the shipping address must match the billing address of the credit card.

Line 1:

Line 2:

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Line 4:

Additional Comments or Special Instructions on your Order

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