Cosmic Guide

Astrological Charts & Readings

Mail Order Form

 

Your Information (Please print clearly)

 

Mail to:

 

Full Name:

 

 

 

Paul Fernandez

4714 Michael Ct Suite 109 Tampa Fl 33614

813.872.553

 

paul@cosmicguide.com

 

Address:

 

 

 

Telephone:

 

 

 

Email Address:

 

 

Birth Date:

(month, day, year)

 

 

 

Type of Chart:

q      Birth Chart (Natal)

q      Relationship (Synastry)

q      Relocation

q      Solar Return

q      Spirituality

 

Time of Birth:

 

                                                   AM or PM

 

 

Birth Location:

(City & State)

 

 

 

If you selected Relationship (Synastry) Chart then you must fill in the information below:

 

If you selected Relocation Chart then please fill in the information below:

Other PersonÕs Birth Date:

(month, day, year)

 

 

 

Relocation City:

 

 

Other PersonÕs Time of Birth:

 

                        

                                 AM or PM

 

 

Relocation State:

 

Other PersonÕs Birth Location (City & State):

 

 

 

 

Please print your three questions here (use back of page if necessary):

 

1.

 

2.

 

3.

 

 

* All charts are $100.00 plus $3.50 for S&H. Charts are non-refundable and are not created until payment is received. Make checks payable to: Paul Fernandez

 

* Please allow 4 Š 6 weeks for delivery.