Rate Card / Online Payment
Name *
Address *
(P.O. box, Street address, City)
Country *
Zip Code *
City *
State *
Phone *
Email *
Service Requirement
After making the payment through VeriSign secured payment portal ccavenue.com, please visit Birth Details / Input page of our website and fill in your full name, date, time and place of birth
Billing Address:

Check if Billing address same as above
Billing Customer Name *
Billing Address *
(P.O. box, Street address, City)
Billing Customer Phone *
City *
State *
Delivery Address:

Check if billing and delivery address is same
Delivery Customer Name *
Delivery Address *
(P.O. box, Street address, City)
Delivery Customer Phone *
City *
State *
Note: * denotes mandatory fields

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