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Step 1: Fill Out Form Below & Submit. Step 2: Mail Payment.
The supplied information will remain confidential
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Astro-Dynamic
Relationship Analysis

OnLine Order Form To Pay By Check:

I accept Checks or Money Orders Drawn ONLY on US Banks. 
 Allow 4 weeks delivery for the Long Term Analysis; 3 weeks for the Intermediate Analysis and 2 weeks for the Prospective Analysis upon receipt of payment. 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-Analysis.
Please make sure it is correct.


SHIPPING INFO & CHECK VERIFICATION

YOUR NAME*:
ADDRESS*:
APARTMENT#:
CITY*:
STATE*: ZIP*:
TELEPHONE*:
EMAIL*:
ANALYSIS TYPE*:
CHECK AMOUNT*:


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