AstroPath Astrology Birth-Data Order Form
(We pledge we will NEVER pass on this information to anyone.)
The following is necessary to do a chart;
however, if paying by Credit Card or
PayPal,
you will be furnishing this at Checkout,
so only entries in Blue are required here.
If NOT Credit Card please fill out all your Confidential Info.
First Name: M.I.: Last Name:
Email: (Required for Internet Orders)
Phone: (Required for Phone Readings and Confirmation)
Street Address (Required if receiving Hard Copy Charts or Reports):
Apt #, etc:
City: State: Zip:
Country:
Date of Birth:
Time of Birth (from birth certificate):
Place of Birth:
Note: If you are submitting a 2nd person (or more) for another
Single, Relationship, Composite Chart,
please fill out this Order Form for each person for whom you want a
chart..
Then SUBMIT at bottom for each.
Are you including another person? Yes
No
If Yes, please enter the name for each other person
you've filled out on other submissions:
1 2
3 4
If you are using this submission for your other person(s), please indicate your name again.
Chart(s): How many charts do you want?
(Note: A Composite or Relationship Chart
is one (1) chart, but 2 or more persons so I need the Data submission for each.)
| Standard
Chart style normally given? (1 Standard Simple5) |
Yes No |
If No, Click to Select a different Chart Style Enter Chart Item #. |
Payment Method?
Credit Card
Or
PayPal
Money Order
Cashier's Check
Personal Check (2 wks to clear)Just use Shopping Cart Buttons here & throughout Site
----------------------------
To submit Personal Info now,
use this Submit button:
[Note: If you are worried about someone
intercepting your email on route,
you can submit on the Secure Server but only with payment by Credit Card.
Simply enter Birth Data and/or more persons
in the Box for Additional Shipping Information]
Payment back at Buy Now buttons.
Back to Main Page for other Astrology info..