LOVE MATCH REPORT - Mail In Order Form
Your 25-30 Love Match Report: Print this form and mail your $30 in postal US money order to:
Pamela Fottrell
310 Boston Post Rd.
Waterford, CT 06385
Name of First Person for the
Report:______________________________
Date of Birth (Month first, Date, Year): ______________
Place of Birth (City, State, Country): __________________________________
Time of Birth (Include AM or PM):
_______________________________________________
Name of Second Person for the
Report:______________________________
Date of Birth (Month first, Date, Year): ______________
Place of Birth (City, State, Country): __________________________________
Time of Birth (Include AM or PM):
_______________________________________________
Correct Email to Send the Report:____________________________
In Case I Need to Contact You:
Your Name:______________________________
Address: ______________
City, State, Zip: __________________________________
Telephone (areas code included): _______________________________________________