Client Information
Full Name:
Email:
Your phone number (with country, city, area codes):
Address:
Address:
City:
State:
Zip Code:
Country:
Birth Information
Birth Date:
Birth Time:
Birth Place: (City, State)
Birth Country:
Gender:
Other Information
Providing an image to the astrologer will help him connect with you
and in return you will receive a more accurate reading. So
please provide the following information if you can.
I can supply a photo of myself via email.
Do you have a picture of yourself on a webpage? If so, please
use the space provided below to indicate where it islocated?
If you can supply us with a photo by email please check the box
below and then email it to ericinvt@charter.net
with your name as the subject, and send it as soon as possible.
Do you have Children?
How Many?
Accurate readings are the result of communication
between Astrologer and Client. Please provide any information about yourself
that may be helpful below. (for example: reason for wanting the reading,
problems you may be having, or interests.)
What is the reason you are seeking a reading?
Payment method
(please check one)
1.) Personal Check
2.) Money Order
3.) Paypal
To finish your order click the "Submit
Button" button below