Secure Order form for Astrology Charts

Your credit card information is SECURE and encoded being sent over the internet. OUR GUARANTEE: If your credit card is used fraudulently due to your order, we will pay any cost (usually a $50 charge for unlawful use).

Your information will NOT be given or sold to ANYONE! All information is confidential!

If your browser does not support forms, OR if you want to send a check or money order you can print out this form and send it with your check or money order made payable to:

Nancee Belshaw, MA, MFT
11600 Washington Place, Suite 110
Los Angeles, CA 90066

* Required Information.


Enter Quantity desired...Click on "Calculate Results" Then complete birth information below.
Reports are beautifully bound -- for a special gift for yourself or a friend.
*Item*	*Qty*	*Price*		*Amount*
Natal Astrology Report		$19.95		$
Daily Forecast 6 month		$28.95		$
Daily Forecast 12 month		$49.95		$
Solar Return Report		$19.95		$
Child Astrology Report		$19.95		$
Pet Report		$19.95		$
Career & Professional Report		$19.95		$
Relationship/Compatibility Report		$19.95		$
Two Natal & Relationship/Compatibility Report		$42.95		$
Relocation Report One US City		$ 4.00		$
Relocation Report Three US Cities		$10.00		$
Daily E-Mail Forecast *No need to select shipping		$ 1.00	*Per Day*	$
Naughty Report		$ 5.00		$
To receive your Free Moon Interpretation OR Free Lucky Days please select one
To Save Shipping and Handling and receive your order by email within 24 hours check this box
Ship within the US		$ 4.95		$
Ship outside the US		$ 8.95		$
			$
			Total: outside California	$

California Residents please check this box		California State Tax $		TOTAL w/ Tax $

**Required Information*
Complete the following to receive: FREE Monthly Lucky Day OR FREE Moon Interpretations!!! Astrology Information:	Where did you hear about us? Please click here for your free Naughty Report with paid order
*Birth Name
*Birth Date (MM/DD/YY)
*Birth Time If birth time is unknown, we will assume 12 Noon	Please include AM or PM
*Birth City, State/Province and Country	Please be sure to include all three!
Information for Compatibility Report Only	(Fill out for the second person.)
This chart is for Friends	This chart is for Lovers
Birth Name
Birth Date (MM/DD/YY)
Birth Time If the birth is unknown, we will assume 12 Noon.	Please include AM or PM
Birth City, State/Province and Country	Please include all three.
Relocation Chart Information:	First City : Second City : Third City :
Solar Return Information:	City you were in on your last birthday: Or If you are ordering a solar return for the coming year add in the city you will be in on your next birthday:
Customer Information:
*Customer Name as it appears on credit card:
*Address:
*City:
*State:
*Zip:
Telephone: We will not phone unless there are questions about your order.
Fax:
*E-mail:
Additional Comments:
Payment:
Type of Credit Card
Card Number:
Expiration Date:

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Thank You For Your Order!