Astrology House Order Form
 


Please print page and fax or post to Astrology House, 41 New North Road, Eden Terrace, Auckland, New Zealand.
Tel/fax + 64 9 373 5304. Or e-mail details requested in form to:

___________________________C____________________________


 


First Name______________________________Last Name____________________________

Address_____________________________________________________________________

Phone Number___________________________Fax Number__________________________

E-mail Address_______________________________________________________________

Type of Chart________________________________________________________________

____________________________________

Date of Birth:

Day______________________Month_____________________Year____________________

Time of Birth:

Hour_________________Minutes__________________AM/PM

Place of Birth:

Town_____________________________Country____________________________________

__________________

Method of Payment:

By cheque or money order please make payable to Astrology House

By VISA/Mastercard include:

Card holder's name________________________________________

Card No_______________________________Expiry date________


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