Mailing Name ______________________________________________

Mailing Address _____________________________________________

City ________________________________ State ________ Zip________

HOWARDSHELDON.COM

Astrological Order Form for
PERSONAL CONSULTATION

Name #1_______________________________________________________

Birthdate (month, day, year) ___________________________________

Birthtime__________ Please circle AM or PM. Please circle sex M or F

Birth Place (City, County, State)

_________________________________________________________

Name
#2________________________________________________________

Birthdate (month, day, year) ______________________________________

Birthtime__________ Please circle AM or PM. Please circle sex M or F

Birth Place (City, County, State) ____________________________________________________________

Total Amount Enclosed_________________

PLEASE INCLUDE A CONTACT PHONE NUMBER

TO REACH YOU: AREA CODE (________)

________________________________________________

Astrological Order Form for
Personal Service
Please print or copy this form and
send it with a money order or
check enclosed in U.S. Dollars.

NOTE! Many states have more than one city
with the same name.
Like Brooklyn, New York.
Surprise, there is more than one
Brooklyn, New York
and more than one Burbank, California.
SO PLEASE, PLEASE TELL ME THE COUNTY
YOU WERE BORN IN.....

One Hour Telephone Consult with Howard Sheldon.
& 6 Month Projection Analysis
includes progressions and hard aspect transits on cassette tape. $250.00

YOUR E-MAIL ADDRESS PLEASE:__________________________________________________