BIRTH DATA FORM

The 1st Step: Submit Birth Data Of Both Parties
The supplied information will remain confidential.

Astro-Dynamic
Relationship Analysis

After you submit the birth data in the form below, you will see a confirmation page with a PayPal button.
Just click on the PayPal* button to complete your order.

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Simply ignore the LogIn box, fill in your CC info and submit.

Allow 6-8 weeks delivery for your Astro-Dynamic Relationship Report upon receipt of payment. You will be notified when when shipping occurs.

Note: The information you submit will be confidential and used only to prepare your Relationship Report.
Please make sure it is correct.

GENERAL INFO

EMAIL*:
ANALYSIS TYPE*:


YOUR BIRTH DATA
REPLACE EXAMPLE TEXT WITH YOUR INFO

YOUR NAME:
YOUR BIRTH DATE: YOUR BIRTH TIME(approx.):
YOUR BIRTH PLACE:

OTHER BIRTH DATA
REPLACE EXAMPLE TEXT WITH YOUR INFO

OTHER NAME:
OTHER BIRTH DATE: OTHER BIRTH TIME(approx.):
OTHER BIRTH PLACE:

OTHER SIGNIFICANT DATES
NOTE: The date of the 1st meeting is useful, but not critical. I use the word physical here to distinguish it from simply passing someone in a car. Usually, a first touch like a handshake, a hug etc. triggers a dynamic and marks the birth of the relationship chart. Occasionally, as in love at first sight, you just know something happened. If so, give that date. Don't worry, few people remember when they first met. Fewer still remember the time. So approximations for the time are OK. Use the comment box to give me an idea of how sure you are about the date of the first meeting. However, if you are not even sure what day it was, just skip it.

FIRST PHYSICAL MEETING: TIME(approx.):
WEDDING DATE: TIME(approx.):

The wedding day, of course, must be accurate. The time is not critical but it is useful. If you know you were married sometime between 2 and 4 in the afternoon, just call it 3 PM and split the difference.

COMMENTS & QUESTIONS
You may add any additional comments, questions and info about your situation
in the text box provided below. The Text Box works like a normal word processor.
You can copy, paste, use the Delete key or the Backspace key, the arrow keys etc.



* PLEASE DOUBLE CHECK all your entries for accuracy.
When you are satisfied, you may press Submit

Thank you.

                            

NOTE: If you click the CLEAR button, all of your entries in the entire form will be deleted.


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