Certificate Request Form printable pdf download

THE STATE BAR OF CALIFORNIA

For Official Use Only

Member Services Center

180 Howard Street · San Francisco, CA 94105-1639

(888) 800-3400 · msc@calbar.ca.gov

Certificate Request Form

Please use a separate request form for each member

PAID ____________

1) MEMBER INFORMATION

Full Name:

Member Number:

2) REQUESTOR INFORMATION

Contact Name:

(

)

E-mail:

Phone:

Send Certificate(s) to this address:

Firm/Agency Name:

Address:

City:

State:

Zip:

3) ORDER INFORMATION

You may request up to 3 total copies per member, in any combination below, for your payment of $25.

Please send me a regular certificate of standing (not notarized). Number of copies:____

Please send me a foreign jurisdiction certificate. Number of copies:____. Please be sure your phone number is included in the

contact information. If paying by check, also include a money order (no personal checks) in the amount of $10 per certificate made

payable to "The UPS Store" to cover notary fees. Please allow for extra processing time.

Please send a complaint check certificate. Complaint check certificates may only be sent to state bar associations and state

supreme courts. I authorize the State Bar of California to release any information related to my disciplinary record to the state bar

or court listed above:

Signature:_____________________________________________________________________________________

Please be aware that certificates required for admission to the U.S. Supreme Court must be purchased from the California

Supreme Court. (See instructions at for details.)

4) PAYMENT INFORMATION

Pay By Credit Card

Visa

MasterCard

Expires (MM/YY):

Card #:

Name On Card:

Billing Address:

Date:

Signature:

By my signature on this document, I/we hereby authorize The State Bar of California to charge my/our VISA or

MasterCard account for the cost of the certificate(s) as well as for any shipping or notary charges requested.

Pay By Check: Make check payable to 'The State Bar of California.'

5) SHIPMENT INFORMATION

Regardless of shipment method chosen, requests for certificates

FAX CREDIT CARD

require at least five business days for processing.

ORDERS TO:

Please mail my certificate(s). (NOTE: CERTIFICATES CANNOT BE FAXED)

Membership Services Center

(415) 538-2576

OR MAIL TO

Please send my certificate(s) by overnight UPS. There is a $10 charge for domestic

Member Services Center

addresses. International mailings will be charged at the rate UPS charges the State Bar.

180 Howard Street

San Francisco, CA 94105-1639

2 0 0 9

MRS304CertReqFRM1108

Certificate Request Form

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