CONTACT INFORMATION
Name....
Mailing
Address
.............
City.......
State/Prov.
Zip/Postal Code
County...
Area Code......
Phone Number..
Ext.
Email
BIRTHDATE:
Month:...
Day:
Year:
BIRTHPLACE:
City:.....
State/Prov.:
Country:
BIRTHTIME:
Hour......
Minute:
AM or PM:
NOTE: If you are ordering the Compatibility Report, please enter the birthdata for the
second person in the spaces below.
Name:
BIRTHDATE:
Month:
Day:
Year:
BIRTHPLACE:
City:
State/Prov.:
Country:
BIRTHTIME:
Hour:
Minute:
AM or PM:
NOTE: If you do not know the person's birthtime, leave blank.
Please check any options you are ordering
Use box below for Mini-Reading information and questions only.
Please enter a description of your situation and your two questions in the box:
Please review the information you have input; the accuracy of the readings depends on it.
When you are sure everything is correct, click on the "SUBMIT" button below.
You will receive an email confirming your order and invoicing you for the correct fees.
