MAIL-IN ASTROLOGICAL SERVICES ORDER FORM [Print this Page] [See comments bottom]

(Select): In-Depth Natal Reading ($120) [_] /// Bottom-Line Natal Reading ($49) [_]
Unique Compatibility Analysis ($65) [_] /// Child's Natal Horoscope Reading ($120) [_]

Name:__________________________________________

Your (or their) Birth Month:_____________Date:___Year:______

Time:______________ (Check One): AM [_] PM [_]

Birth City:_____________________________________________

State/Country:____________________________________________

Gender (Check One): Female [_] Male [_]

Working Printer? Yes [_] No [_]

Your Address:

Street or Post Office Box:______________________________

City/State:____________________________________

Zip Code:______________

Contact Phone (Required)____________________

Email Address (Required)_________________________

"OPTIONAL" COMMENTS~INFORMATION~QUESTIONS

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[Note: USD only -- Money Order/Personal Check -- or Cash (Not highly recommended).
Personal/Business checks require at least 7 business days to clear.]

Mail to: Elbert Wade, 3847 FM 2423, Grapeland, Texas 75844-9061

Copyright 2017