Astrology Information Form

In order to receive accurate information from an astrological chart, I must have the following information. You can generally find this information on your birth certificate. If you do not have a copy of you birth certificate, you can obtain one from the county clerk in the county where you were born. Please make sure that you ask for a "detailed" copy of your birth certificate. If you cannot obtain this information, just fill out all that you can.

Current Information

Name:

Address:

City:

State/Zip:

Phone:

E-Mail:

Birth Information

Full Name At Birth

First Middle
Last

Date of Birth

xx/xx/xxxx

Birth Time

AM. or PM.

Place of Birth

City State

Current City Where You Spent You Last Birthday

City State

Current City Where You Will Spend Your Next Birthday

City State

Birth Time Source

Payment Type

To receive a written report, charts or an individual chart analysis:

Payment Will Be Made:

Pay with your credit card or debit card: We accept payments through PayPal. This safe and secure service allows our readers to pay instantly online using their credit cards, debit cards, or e-checks. The process is easy and safe, and you are not required to register with PayPal in order to complete this transaction.

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If you would like to send a check or money order by mail, the checks should be made payable to "Kristin Idema" and mailed to the address on Contact Page. Payment should arrive at least 1 week before reading date or before reports are sent.

Questions or Comments?