Customization Form B

The purchaser's name, diploma name, and choice of white or parchment paper must be entered. Also, the graduate's name, date of graduation, home school name, and your email address must be entered. All other fields are optional. You may pay via Paypal or via a check or money order. More information about payment is on the orders page. Checks and money orders can be made out to R. D. Williams and sent to: R. D. Williams, 1811 Plains Blvd., Powell, Ohio 43065.

Purchaser's Name (required)
*Purchaser's E-mail Address (required)*
*Which Diploma Did You Purchase? (required)*
*Payment Method (required)*
*White or Parchment Paper (required)*
Exact Spelling of the City and State on the Diploma (required)
Exact Spelling of Graduate's Name on Diploma (required)
*Graduation* Month on Diploma (required)
*Graduation* Day on Diploma (required)
*Graduation* Year on Diploma (required)
Email *Your Own Picture to include on* Diploma for an additional $5.00?
(Add $5.00 to your payment if yes & email photo to webmaster@diplomastore.com) Pictures provided by you must be quality jpg files. If you can print it on your printer or at any digital print service online or at your local store with satisfactory results, it is a quality photo. If you have already paid via PayPal, we will send you a separate invoice for the additional $5.00).
Home School Name (required)
If this is a gift item that will be sent to a different address than the billing address, please enter the shipping address below. If this item will be paid for via check or money order, please enter the shipping address below. Leave this section blank if the item will be shipped to the same address as the address in PayPal.
*Shipping Name*
*Shipping Address 1*
*Shipping Address 2*
*Shipping City*
*Shipping State / Province*
*Zip Code / Postal Code*
*Shipping Country*
*Enter a Special message to be placed on a free gift card that we enclose when sending the diploma to a different address than the billing address* or *Any additional information you wish to provide*

Customization Form B

Customized Diploma Request Form

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Send mail to webmaster@diplomastore.com with questions about this novelty Diploma Store or our products.

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Last modified: July 16, 2009