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Numerology Reading Order Form
$100 (including GST and Postage)

Format:
[ ] Audio Cassette [ ] CD

Information required for the Numerology Reading:
Name on Birth Certificate: _______________________________________
Birthdate: ________________________________

Information required for mailing you the Cassette or CD:
Current Name:____________________________
Address:_________________________________ Post Code: _______
Phone Number:__________________________

Payment method:
[ ] Cheque/Money Order (Payable to Dr Peter Filis) (Print this page and mail to:

Dr Peter Filis
Northwood St, NEWTOWN NSW 2042
Fax: 02 9519 6833

Credit Card Payments
[ ] Visa [ ] MasterCard [ ] Bankcard [ ] AMEX
Name on Card:____________________________
Credit Card Number: _____________________________
Card Expiry:_________________________

 

Signature: __________________________

Dr Peter Filis
Numerologist - Palmist - Tarot Interpreter
Northwood Street NEWTOWN NSW 2042 AUSTRALIA
Mob: 0409 652 191 Fax: 02 9519 6833
Email:
drpeterfilis@psychicpower.com.au

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