|
|
|
|
|
Transit Report Order Form
Please print out and mail this form or a hand-written facsimile including all the information requested, with your check or money order to the address at the bottom of this form.
Name: _
E-Mail: _
If you supply us with an E-Mail address, we will notify you by e-mail when we have received your order and give you an approximate date when your order will be sent to you.
Address: _
City/Town: State: _
Country if other than the U.S.: _
If this chart is for some other than yourself, please enter that persons name
Name on Report: _
Date of Birth: Month: Day: Year: _
Time of Birth: Hour: Minute: AM?PM? _
Example: 3:47PM
Place of Birth: City/Town: State: _
Country if other than the U.S.: _
Current Place of Residence:
City/Town: State: _
Country if other than the U.S.: _
Please select the appropriate Report and fill in the
appropriate dates. Place a check by the report(s) you are ordering.
__ONE-DAY Transit Report for: $ 10.00
Month: Day: Year: _
__TWO-WEEK Transit Report beginning: $30.00
Month: Day: Year: _
__ONE_MONTH Transit Report beginning: $50.00
Month: Day: Year: _
__ONE_YEAR Transit Report beginning: $200.00
Month: Day: Year: _
Personal Checks or Money Orders accepted. I try to avoid credit cards...they only get you in trouble.
Please make checks or money orders payable to: Elaine Becker
Remit to: Elaine Becker
P. O. Box 216
Cosby, Tennessee 37722
Questions and/or comments may be directed to: Womynstar@aol.com
|
|
|
|
|
