ABRA-KADABRA SYSTEMS
14 Windsor Rd. - Medford, MA 02155 - USA
Fax:(781)391-2282 - Email: magicjim@rainho.com

ORDER FORM FOR PSYCHIC CYCLE CHART

Today's Date:
Name:
Address City: STATE:
Zip Code Number:Country
Phone: Fax: Email
Payment Method: By Check- by Money Order- by Bank Draft- by Credit Card
Credit Card Information (if paying by this method): Card Type: Master Card - Visa
Name on Card: Card No. Exp. Date

(Note: Credit Card minimum orders is $25.00)

CHART FOR: (NAME)

DATE OF BIRTH OF PERSON NAMED ABOVE:

MONTH:

DATE:

YEAR:

CHART TO START ON THE 1ST. DAY OF (MONTH):

IN THE YEAR OF:

TOTAL DUE:

Thank You.

CHARTS WILL BE SENT EACH MONTH BY U.S. MAIL.

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