*This form should be used by TRINITY
COLLEGE ALUMNI
ONLY ordering a reprint of their credentials. Please complete
this form for each degree (each reprint) request.
Student
Information
Student ID Number:
Type Your Name EXACTLY as it is printed on
the diploma:
*Original Trinity
College Approved
degree:
(MUST MATCH
OUR RECORDS)
*Major you were
originally issued:
(MUST MATCH OUR RECORDS)
*Please enter the
DATE of your diploma:
(MUST MATCH OUR RECORDS)
Credit
Card Information
Card Number:
Expiration Date:
(MMYY)
CVV:
Billing
Information
Billing Name:
( First + Last)
Full Billing Address:
Phone Number:
Fax:
E-Mail
Address:
(*Please double
check to make sure your e-mail address is
correct. This is how we will contact you.)
Shipping Address
(If different from billing)
Note: We
cannot ship to a P.O. Box. We ship
exclusively using UPS and this carrier
will not ship to a P.O. box. APO
addresses, however, are acceptable.
My billing and shipping address are the
same.
*
Name ( First
+ Last)
Company
*Full Mailing
Address:
(No P.O. Boxes
PLEASE!)
Alternate Telephone Number:
Notes/Comments:
Please Select a Package
*Please select the reprint package and the
DOLLAR AMOUNT (US$) you authorize us to
charge to your credit card:
