nh-jp.com  -  James C. Webb Sr.

Civil Union Client Information Sheet

Date of Civil Union            ________________________Time______________

Place of Civil Union            __________________________________________

Date of Rehearsal            _______________________  Time  _____________

# of people attending       __________________________________________

# of people in the Union party _____________________________________

 Participant #1  Information:

Name:    
Address:  
Town/City   
State     
Zip code    
Telephone#    
Cell #   
Email  Address  
* Drivers Licenses Number  

 Participant #2  Information:

Name:    
Address:  
Town/City   
State     
Zip code    
Telephone#    
Cell #   
Email  Address  
* Drivers Licenses Number  

*Only complete this information if you would like me to perform your Civil Union ceremony. (Positive identification is required prior to all Civil Unions being preformed.) Passports ,Military ID are accepted Please write down what ever you used at the town hall to get the Civil Union license application.

( 50% or $50.00 the greater of the two ) deposit is required to reserve dates and times. The deposit is non refundable .

Please send completed form to:

James C. Webb Sr.     jim@nh-jp.com

6 Independence Ave

Derry, NH 03038

office (603)216-5159   cell  (603) 867-2708