ASTRO*INTELLIGENCE ORDER FORM

CUSTOMER DETAILS:
NAME:(Mr Mrs Miss Ms )________________________________________________

ADDRESS_____________________________________________________

SUBURB _____________________________ STATE___________ POSTCODE:________

TEL (home)(____) ___________________ TEL:(Work)(____)___________________ 

MOBILE:  __________________________      MAILING lIST  Y / N

NAME ON REPORT: ______________________________________________   (M / F)

BIRTH DATE:	    ____/______/____

BIRTH TIME:	    __________________  AM   PM (Circle one)

BIRTH TOWN:	    ______________________________ STATE: _____________

BIRTH COUNTRY:  _________________________________

START DATE:	    ______________________________  (For Transits/Calendars)

REPORT TYPE:    ______________________________________________________________

(Use separate form for additional people)

	
            SUMMARY OF REPORTS ORDERED

Qty               Item                         Price           Total								

____	____________________________________   $_________      $_________

____	____________________________________   $_________      $_________

____	____________________________________   $_________      $_________

DISCOUNT OF 10% OFF FULL PRICE FOR ORDERS $200 OR MORE         $_________

Prices include postage & handling in Australia  ORDER TOTAL:   $_________


PAYMENT METHOD (CIRCLE ONE)  VISA    MASTERCARD    BANKCARD    CHEQUE


CREDIT CARD DETAILS:

NAME ON CARD:  ______________________________________________________

				
CARD NUMBER: ________/________/________/________  EXPIRY DATE: ____ / ____


SIGNATURE:  ______________________________________


Astro Intelligence
P.O. Box 4322, East Gosford, NSW 2250
Phone 1800 811 360   Fax 02 4384 6027                             28/7/00