SNAIL-MAIL ORDER FORM

Step 1: Fill Out Form Below & Submit. Step 2: Mail Payment.
The supplied information will remain confidential
.

Astro-Delux
Transit Analysis

OnLine Order Form To Pay By Check:

ONLY Checks or Money Orders Drawn on US Banks are accepted. 
 Allow 4-6 weeks delivery for the Astro-Delux Transit Analysis upon receipt of payment and clearing of funds by the respective banks . You will be notified when your check is received and when shipping occurs.

Remember To Mail in your payment: made payable to:

John J. Falone
P.O. Box 2905
East Liverpool, OH 43920

Note: The information you submit will be used to prepare
your Astro-Delux Transit Analysis.
Please make sure it is correct.


SHIPPING INFO & CHECK VERIFICATION

YOUR NAME*:
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YOUR BIRTH DATA
REPLACE EXAMPLE TEXT WITH YOUR INFO

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

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 PRESS THE CLEAR BUTTON , ALL OF YOUR ENTRIES IN THE ENTIRE FORM WILL BE ERASED
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