Mail In Order
Robert Koch: Vedic Astrologer
Mail-In Order Form
Fill in and mail this form to: Robert Koch
2320 NE Holliday Ave. #3
Bend, OR. 97701-6637
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 product you want.
(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: $195 __ By Phone
____ Relationship Compatibility, 90 minutes: $225 __By Phone
____ Yearly Update 60 minutes: $175 __By Phone
____ Yearly Update 90 minutes: $195 __By Phone
____ Moon Transit Calendar: $45
($35 with Basic Life Reading, Yearly Update, or Detailed Life Reading.)
Amount Enclosed: $_____________
Thank you for your order!
