IHS Biorhythm - PRINT ORDER FORM

IN-DEPTH COMPATIBILITY ORDER FORM

NOTE: All reports are sent by US Mail.
Prices shown are for all addresses WORLDWIDE (for a limited time).
Prices are US dollars.

The In-Depth Compatibility Report is only $20.00 (Value: $45 - $95).

Print out this page, add your name and address, and mail it with a check or money order (US dollars)
(made out to: Richard Hussey & Associates), or with your credit card information.

One In-Depth Compatibility Report is: $20.00

First Person:

Circle either Male or Female

Date of Birth:

Month

Day

Year

Place of Birth:

Country

Second Person:

Circle either Male or Female

Date of Birth:

Month

Day

Year

Place of Birth:

Country

Relationship of these two people:

In-Depth Compatibility Bonus:
Ask one question about this relationship. Irene will answer as best she can.

Details for delivery:

Your Name:

First then Last

Street Address:

City / County:

State:

Zip Code:

Country:

Phone Number :

(Work)

(Home)

Email:

We do not sell your Email to third parties

Special Instructions:
(With regards to your contact information, etc.)

Print out this page, add your name and address, and mail it with a check or money order (US dollars)
(made out to: Richard Hussey & Associates), or with your credit card information.

PRINT THIS FORM AND SEND TO:

Richard Hussey & Associates
P. O. Box 500280
Malabar, FL
USA
32950-0280

Concerns? Phone: (321) 725-8806