Mail In Order
Robert Koch: Vedic Astrologer
Mail-In Order Form
Fill in and mail this form to: Robert Koch
5916 W Port Ln Apt. 103
Boise, ID 83703-4890
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!
