Another way to order
the Analysis of your Birth Chart (Western Astrology)
Fill the
present Order Form up…
You'll then have the choice to send it to us
(by pressing the SEND THIS ORDER
FORM button)
or to communicate it via e-mail
or even by postal mail (Delemme Diffusion SARL - 5, Les Sources 07130 Soyons France).
Information
on you
Firstname :
Name :
Gender :
F
M
Date of Birth (Day Month Year) :
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2013
Hour of Birth (Hour Minutes)
Hour: [0,23]:
00
01
02
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City of Birth :
Country of Birth :
E-Mail :
Postal
Address:
Phone:
Information on your Order
I order an Analysis
Western Analysis of my Birth Chart 190 Euros
Remark :
the prices written on the present Order Form are the only
official prices and replace any other prices mentioned
elsewhere.
To pay with a Credit
Card... (If
you find more secure with a phone call, send us an E-Mail
explaining
where you live and we'll define a rendez-vous). To
Order by Check or Western Union...
Type of the Credit Card :
VISA
MASTERCARD
Name of the
Owner (as
written on the card)
Number of the
Card :
Please enter your
visual cryptogram , i.e. the three last digits
written on the back of your card:
Expiration
date :
01
02
03
04
05
06
07
08
09
10
11
12
2013
2014
2015
2016
2017
2018
2019
2020
2021
2022
2023
Possible comment:
Please
double-check the following fields: -
E-Mail address(if you want us to reply!),
- Date of Birth ,
- Hour of Birth ,
- Number of your Credit Card, -
Expiration date of your Credit Card, -
Your cryptogram (otherwise,we'll ask it by
email).
Thank
you...
DELEMME Diffusion Ltd. - 5, Les
Sources - 07130 Soyons - FRANCE info@delemme.com
[ Comparison
with other currencies ]
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