Virgo Astrological Services Order Sheet

Last Name_________________________________________________________________

First Name____________________________Middle Name__________________________

Address____________________________________________________________________

Street__________________________________________________Zip_________________

Phone (______)______________________Fax Number__(_____)_____________________

E-mail Address______________________________________________________________

Report(s) you are ordering________________________________________________________

for COMPATIBILITY REPORT specify: ____Husband/Wife ____Lovers____Friends____Partners

Last Name_________________________________________________________________

First Name___________________________Middle Name/s__________________________

Date of Birth: Month_______________Day________________Year___________________

Time of Birth: (if available) Hour___________Minutes____________AM/PM___________

Place of Birth: City_________________________State/Country_______________________