CynthiaChomos.com

Personal Directions Chart

Check below:			First Name:	month/date/year: (example 11/22/57)
	1st chart	$15	Name:	Birthdate:
	2nd chart	$10	Name:	Birthdate:
	3rd chart	$5	Name:	Birthdate:
	4th chart	$5	Name:	Birthdate:
	5th chart	$5	Name:	Birthdate:

Note: If you were born in the Southern Hemisphere, please note this information in the Special Instructions box during PayPal checkout.

Subtotal: $

Shipping: $

Total: $

Send chart(s), free Furniture Tips and Bonus Report to the Purchaser at the following address:

Name:

Address:

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Phone:

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Comments: Please use the Special Instructions box during Paypal checkout if you or a family member were born in the Southern Hemisphere or for other comments.