STEP 1 - Personal Information Form

3 Easy Steps! 

First, in order to process your order, we must have your specific astrological and personal information in order to perform your "Personalized Readings". Your privacy is very important to us and will not be sold nor shared with anyone outside of this website.

You must enter all the information correctly to assure that your reading is accurate and that we may contact you in case there is additional information needed!

Once all questions are answered - click STEP 2 button only once  please. Thank-you!

 

First Name  * Verification: Mandatory
 

Last Name
 
* Verification: Mandatory
 
Address (Current) * Mandatory
 
City (Town, Locality)* Mandatory
 
State (Province, Region, etc.)* Mandatory
 
Zip Code  (Mail Code)* Mandatory
 
Telephone (Area Code & Telephone No.) * Mandatory
 
Email * Please Verify: Mandatory
 
Date of your Birth (example: 01/01/1966) * Mandatory
 
Time of your Birth (example 2:35 AM or unknown) * Mandatory
 
The City, Town, or Borough of your Birth  * Mandatory
 
The State of your Birth * Mandatory
 
Country of your Birth * Mandatory
 
Country reside today * Mandatory
 

 

Marital Status
( Select One )
Single
Looking
Married
Divorced

Additional Comments:


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