Please enable JavaScript in your browser to complete this form. OFFICE USE: DCN ________________________ M # _______________SPECIAL HANDLING REQUESTED THROUGH USAHR OFFICEComplete this Order Form and email or Print out and Use this Order Special Handling Fees, for all work to be done by the Registry. This Order form MUST ACCOMPANY the request or your paperwork will be returned with no processing. The Order form is vital to keeping costs down for the Registry. Base (individual) membership is required. The Registry needs for tax purposes and for its own records to have an accounting of these fees charged within the Registry for work performed. Thank you for including this page with all your requests which involve any money fee. Base individual membership is required.REQUIRED INFORMATION. There is a $25 fee added for re-submission when an application has been returned. DO NOT SEND CASH. DO NOT SEND A PERSONAL CHECK. They will be returned to you with no action taken on your request or paperwork. CheckboxesSpecial Handling Fee $25Rush/special certificate $25Express processing next day $502 or 3 business days $50Miscellaneous TBD $3CC Convenience fee 3% credit cardsTotal Fees Due for Special Services$ 0.00Select which Payment Method is to be used. Remember. No personal checks are accepted. No credit card information is retained by USAHR at any time. *Cashier’s Check, not a personal check Money OrderCredit CardSquare *Credit Card field is disabled, Square payments are not enabled in the form settings.Square is being used as the payment gateway for Credit Cards because the cost is 4% manually entered and through a secured agent. You must complete the Credit Card information if using a credit card. There is a required 3% Convenience Charge which MUST be added to the final payment. If using Cashier's Check or Money Order please mail to USAHR, PO Box 423, Littlefield, TX 79339. Allow 2 to 4 weeks processing as USPS is slow.Name the other Credit Card to be used if not Master or VisaIs the Name on Credit Card Same as Membership NameEnter the Credit Card Number Enter the name exactly as shown on the Credit CardExpiration Date month/yearEnter three digit Security Code Include the Fees with either of these requested actions, Membership or Registration. There is a special space created for the additional total cost of Special Handling fees. THANK YOU. When you click on SUBMIT your information goes directly to the USAHR office. SUBMIT