Report Order Form

Note: You must be 18 years of age or older to place an order.

Please provide the following information. Fields marked by an asterisk (*) must be completed.

FULL NAME*
EMAIL ADDRESS
MAILING ADDRESS*
CITY*
STATE OR PROVINCE*
ZIP OR POSTAL CODE*
COUNTRY*
HOME PHONE NO.

Check All That Apply:

Birth Chart & Interpretation. Describes personality characteristics, talents and needs in relationships ($25/$40 for 2 reports).
Transit Report for Upcoming Year. Your own personal horoscope following changes in your life over the next 12 months ($25/$40 for 2 reports).
Compatibility Analysis. Compares two charts and describes weak and strong points between you ($25/$40 for 2 reports).

Birth Information:

NAME*

MONTH* DAY* YEAR*

CITY/STATE OF BIRTH*

COUNTRY OF BIRTH* (If small town outside USA, what is nearest large city?)

TIME OF BIRTH* AM PM (The more exact the time, the more accurate your report or reading will be. If birth time completely unknown, enter 0 pm. )

Information for Second Person (if any):

NAME

BIRTH MONTH DAY YEAR

CITY/STATE OF BIRTH

COUNTRY OF BIRTH (If small town outside USA, what is nearest large city?)

TIME OF BIRTH AM PM (The more exact the time, the more accurate your report or reading will be. If birth time completely unknown, enter 0 pm. )

Please indicate under "Comments" if you would prefer to have the report emailed to you.

Comments:

PAYMENT: You can pay for your order as follows (choose one):
Fax your credit card information to us at 505/466-3500. If the fax does not respond, please call us at 505/466-3500.
Mail your check, money order or credit card information to: Stargazers, 109 Los Hornos Road, Lamy, NM 87540 USA. (US Funds only, please.)
Pay by credit card on-line by providing the following information:

Payment method:    



Card Holder Name:  


  
Expiration Date:   





Card Number:

We'll prepare and mail or email your report within 5 days of receipt of payment.

If you submit this form successfully, but do not receive verification within five days, you should contact us directly by e-mail.