Mail In Order

Robert Koch: Vedic Astrologer
Mail-In Order Form

Fill in and mail this form to: Robert Koch

760 NW Broken Arrow Rd.

Bend, OR. 97703-9037

Your Name___________________________________________________ Address    ______________________________________________________

City/State/Zip__________________________________________________

Daytime Phone______________________________

E-Mail Address_____________________________

Male Female (Circle One)

Date of Birth __________________
Time of Birth ____________________
City/State/Country of Birth_______________________________________

What issues would you like addressed in your reading?

_______________________________________________________________________

_______________________________________________________________________

_______________________________________________________________________

Please check which reading you would like to schedule:

(If you would like to have the recording done during a phone conversation, place a check mark in front of “By phone.”)

____ Basic Life Reading: $225 __ By phone
____ Detailed Life Reading: $300 __ By phone
____ Relationship Compatibility, 60 minutes: $200 __ By Phone
____ Relationship Compatibility, 90 minutes: $250 __By Phone
____ Yearly Update 60 minutes: $175 __By Phone
____ Yearly Update 90 minutes: $195 __By Phone
____ Moon Transit Calendar: $45

Amount Enclosed: $_____________

Thank you for your order!

 

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