Astrology Soul Connection Astrology Readings Print this form & Mail or Fax it to us!

Thankyou for choosing Astrology on the Web with Soul Connection. Your astrology report will arrive beautifully bound, with a clear interpretation and well-drawn chart. You should receive your order within 21 days. 1. TO PLACE AN ORDER Telephone: If you are paying by credit card, we accept telephone orders 9am to 6pm AEST Mon-Fri. Please review the following and call +61 2 4861 3600 with your order. Fax: Alternatively you may send completed forms by fax to: +61 2 4861 2208 Mail: If you are paying by check or wish to mail the order, complete and send to: Astrology on the Web PO Box 1910 Bowral NSW 2576 Australia Internet/Web: We also offer an instant online ordering service at http://www.astrologycom.com/order1.html or click to email us on orders@astrologycom.com 2. PRODUCT SELECTION Chart Name Value Qty Total Birth Star (brief) $19.95 [ ] $_____ Birth Star (standard) $39.95 [ ] $_____ Birth Star (intensive) $69.95 [ ] $_____ Squarebound $35 [ ] $_____ Clothbound $50 [ ] $_____ Leatherbound $70 [ ] $_____ Personal Prediction (1 month) $35 [ ] $_____ Personal Prediction (3 months) $105 [ ] $_____ Year Ahead - 12 month forecast $250 [ ] $_____ Squarebound $35 [ ] $_____ Clothbound $50 [ ] $_____ Leatherbound $70 [ ] $_____ Relationship Analysis $49.95 [ ] $_____ Soul Connection (standard) $39.95 [ ] $_____ Soul Connection (intensive) $59.95 [ ] $_____ Compatibility Report $29.95 [ ] $_____ Combination Special $99.95 [ ] $_____ Intensive Power Combination Special $149.95 [ ] $_____ Squarebound $35 [ ] $_____ Clothbound $50 [ ] $_____ Leatherbound $70 [ ] $_____ Sub-Total $_____ (Shipping and Handling: $7) Post $_____ Total $_____ 3. PAYMENT INFORMATION [ ] Check/Money Order (US$ Funds only) or [ ] VISA [ ] MasterCard [ ] AMEX [ ] Diners Credit Card Number: |__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__| Expiry: |__|__/__|__| Name on credit card: _____________________ Billing Address: ___________________________________________________ City: ______________ State: _____ Country: _________________ Code: __________ Telephone: (____) _____ - _________ Email: _________________ Signature: __________________________________ Date ________________ 4. DELIVERY INFORMATION [ ] Check this box if same as above Name: ____________________________________ Address: ___________________________________________________________ City: ______________ State: _____ Country: _________________ Code: __________ Telephone: (____) _____ - _________ Email: ________________ Any special instructions? __________________________________________ 5. READING INFORMATION Name of Person: _______________________________________________ (Use the name as you wish it to appear on report) Date of Birth: Day |__|__| Month |__|__| Year |__|__| __|__| Please write name of month here in full: ______________________ Time of Birth: |__|__:__|__| ____ (AM or PM?) Place of Birth: ________________________________ State: ____________ Country: ____________________ Gender: M / F     Nearest Major City: _________________ 6. ADDITIONAL INFORMATION FOR SPECIFIC READINGS a. For Forecast Start Date: Day |__|__| Month |__|__| Year |__|__| __|__| Please write name of month here in full: ______________________ b. For Relationship Analysis & Soul Connection Name of Second Person: _______________________________________________ (Use the name as you wish it to appear on the report) Date of Birth: Day |__|__| Month |__|__| Year |__|__| __|__| Please write name of month here in full: ______________________ Time of Birth: |__|__:__|__| ____ (AM or PM?) Place of Birth: ________________________________ State: ____________ Country: ____________________ Gender: M / F     Nearest Major City: _________________ c. Specific Questions to be answered with detailed interpretation or combination charts 1 _______________________________________________ 2 _______________________________________________ 3 _______________________________________________ 7. ORDERING FOR MORE THAN ONE PERSON? If you are ordering readings for more than one person, please copy or print Section 5 and (if required) Section 6 for each person. 8. PLACING YOUR ORDER Thank you for completing this form. You may place your order by: Fax: +61 2 4861 2208 Mail: Astrology Soul Connection PO Box 1910 Bowral NSW 2576 Australia Telephone: +61 2 4861 3600 Call us Mon-Fri, 9am to 6pm AEST. website: http://www.astrologycom.com or click to email us on orders@astrologycom.com

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