Astrographix ~ Birth Charts ~ Order Form


Your email address:
	(your own email address)

	If this is a gift, we will send the chart download information to both you and the gift recipient after the chart has been created.
This is a gift:	Send to recipient email address -


	Enter the following information as you would like it to appear on the Birth Chart. If you are unsure of some details, you'll have a chance to edit it once you've received the chart.
Full Name:
	(full name including any middle names)

Preferred Name:
	(e.g. Susan likes to be called Sue, George likes to be called Rusty)

Gender:	Male Female

Birth Date:
Birth Time:
	(If you don't know the time, that's OK. Traditional astrology advises to use 12 noon on the date of birth if you don't know)

Birth State/Country:
Birth Place:
	(as you want it to appear on the printed chart)


Print Format:

	If you have a coupon, please enter that code below.
Coupon Code:

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