Reiki Certificate Custom Design Order Form

*(denotes required field)

■ First Name: *

■ Last Name: *

■ E-Mail Address: *

■ Extra E-Mail Address: *

This is to be used in case we can not reach you.
Commonly used free e-mail is recommended,
such as Gmail, Yahoo Mail.

□ URL of your School/Organization (if any):

Just for our translating and designing reference.

■ Layout Format (Landscape only): *

Letter Tabloid A4 A3

Please select one.

■ Border Design: *

Dragon Phoenix No Border (blank)

Please select one. View Borders

■ Japanese Text Font: *

Font1 (preferred) Font2 Font3

Please select one. View Fonts

■ A. Heading Text: *

View Text Items

■ B. Name of the Award Recipient: *

One person's name.
View Text Items

□ Name Pronunciation Guide:

Required if the name is pronounced in non-English,
or difficult to read.

■ C. Specified degree/level: *

e.g. "3rd Degree Reiki" View Text Items

■ Label Text: *

■ D. Award Text: *

default: This is to certify that the person mentioned above has received the necessary attunements and attained the specified degree of Reiki in the traditional Usui Shiki Ryoho (or your Reiki style).

Please be in 50 English words. View Text Items

■ E. Date of Award: *

View Text Items

□ Date Format:

N/A Month/Day/Year Day/Month/Year Year/Month/Day

If the above is written in numerical notation,
please select one.

■ Label Text: *

■ F. Name of the Conferrer: *

One person's name. View Text Items

□ Name Pronunciation Guide:

Required if the name is pronounced in non-English,
or difficult to read.

□ Title of the Conferrer:

If any. e.g. "Reiki Master"

□ G. Reiki Style:

If any. e.g. "Traditional Usui Shiki Ryoho"
View Text Items

■ G. Name of the school, class, etc.: *

■ Hanko Stamp Image 1 (School Name): *

Positive Type Negative Type None (blank)

Please select one. View Items

■ Hanko Stamp Image 2 (Conferrer): *

Surname only Surname and Brief Tittle None (blank)

Please select one.

□ Brief Title (if any):

If any. Please be in brief. e.g. "Sensei"

■ Logo Image: *

Default Image Customer's Image None(Blank)

Please select one. View Items
If you chose "Customer's Image",
please send the image file via e-mail to us later.
For details, please refer to the confirmation e-mail.

■ Watermark: *

None Same as the Logo image Another Image

Please select one. View Items
If you chose "Another Image",
please send the image file via e-mail to us later.
For details, please refer to the confirmation e-mail.

□ Additional Description:

If any terms of Japanese origin,
please let us know about them.
e.g. "Bujin Reiki" Bujin, meaning Martial God

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