Birth Information (Single Report Purchased) Purchaser’s Name* Purchaser’s First Name Purchaser’s Last Name Purchaser’s Contact Email*The report will be sent to this address. Purchaser’s Phone Number*Which Reports Would You Like?*Choose YOUR Report belowSelect Your ReportLife Progression ReportNumerology ReportOpportunity ReportPast Life ReportRelocation ReportSimpatico ReportSolar Return ReportTarot ReportTimeline Forecast ReportSpiritual Path ReportRelationships/Friends and Lovers ReportPersonal Astrology ReportOptimum Child ReportRequired Birth InformationCustomer Name* Customer First Name Customer Last Name Customer Contact Email*The report will be sent to this address. Customer Phone Number*Birth Date and TimeFill out your date of birth and your time of birth below.Date*Date12345678910111213141516171819202122232425262728293031Month*MonthJanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecemberYear*Year202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Don't Know Time of Birth*If you do not know the time of birth, check the box below and we will use the time of sunrise. I Don't Know I Know The Birth Time Birth Time*Input the time you were born in the format hh:mm Example- if you were born at 4:22, input 04:22. Hours : Minutes AM PM AM/PM Birth LocationCity*What city were you born in?U.S. StateSelect the state you were born in.NoneAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces PacificCountrySelect the Country you were born in.AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCosta RicaCôte d'IvoireCroatiaCubaCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFaroe IslandsFijiFinlandFranceFrench PolynesiaGabonGambiaGeorgiaGermanyGhanaGreeceGreenlandGrenadaGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSudan, SouthSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.YemenZambiaZimbabweIf you chose Relocation Report, which EXACT city (One) are you considering relocating to?*Only required if you selected Relocation Report as one of your 3 reportsIf you chose the Simpatico Report, please input partner's birth information below.*Only required if you chose the Simpatico Report for one of your 3 Reports. Include partner's 1) First and Last Name 2) Birth Date 3) Birth Time 4) Birth City and StateIf you chose the Tarot Report, what is your question?* Only required if you chose the Tarot Report as one of your 3 Reports. Examples of things to ask questions about: Relationships, Love, Career, Guidance, the Future, Fortune/Money2nd Person Birth Info or CommentsBirth Information (Single Report Purchased)* Price: NameThis field is for validation purposes and should be left unchanged. CONTACT TODAY FOR PERSONAL CONSULTATION Call Joseph Now! - 480 463 1540
