SNAIL-MAIL ORDER FORM

STEP 1: Fill Out & Submit This Form. STEP 2: Mail Check
The supplied information will remain confidential.
Astro-Delux Destiny Reading

Electronic Order Form For Check Payment:

I accept Checks or Money Orders Drawn ONLY on US Banks.  
Due to overwhelming demand, Please Allow 12-14 weeks delivery for your
Astro-Delux Destiny Reading upon receipt of payment.
You will be notified when your check is received and when shipping occurs.

Remember To Mail in your payment: made payable to:

John J Falone
P.O. Box 2905
East Liverpool , OH 43920

Note: The information you submit will be used to prepare your Astro-Reading.
Please make sure it is correct.

SHIPPING INFO & CHECK VERIFICATION

YOUR NAME*:
ADDRESS*:
APARTMENT#:
CITY*:
STATE*: ZIP*:
TELEPHONE*:
EMAIL*:
ANALYSIS TYPE*:
 CHECK AMOUNT*:


YOUR BIRTH DATA
REPLACE EXAMPLE TEXT WITH YOUR INFO

YOUR NAME:
YOUR BIRTH DATE: YOUR BIRTH TIME(approx.):
YOUR BIRTH PLACE:

COMMENTS
You may add any additional comments, questions and info about your situation
in the text box provided below. The Text Box works like a normal word processor.
You can copy, paste, use the Delete key or the Backspace key, the arrow keys etc.



* PLEASE DOUBLE CHECK all your entries for accuracy.
When you are satisfied, you may press Submit
Thank you.

                            

NOTE: Clicking the CLEAR button will delete all entries in the form

"We are children of the stars...and by them we shall find our way home." jjf