You can download the form from here http://www.groireland.ie/apply_for_a_cert.htm
fill in SECTION 1 - Tick the Email option if you want the cert emailed to you
Leave SECTION 2 blank
Fill in SECTION 3 - Tick the photocopy box for the €4 research option (same info a cert, but it's an image of the actual register)
Put the info from Familysearch onto another sheet, making sure you give the Volume and Page number..
Post it all off or scan it back into the computer and fax it to them on this number 90 6632999