Gem Recommendation Order Form
Instructions: 
There are several ways to order a horoscope
1.	E-mail your order to us. Prepare a short e-mail letter containing the information required on the Order Form and e-mail it to: Acharya@paramhansa.com. with a Heading "Paid Order" So that your order may not get mixed with Free Channel  
When completing the Order Form, note these points:
o	Type or print clearly. Double-check your entries.
Spell out all dates: e.g., April 3, 1903...Not 4/3/03 or 3/4/03. 
o	Your birth information must be correct. Incorrect birth data may result in disappointing inaccuracies in the horoscope. Check your birth certificate, family records, or some reliable source to obtain this information.

The birth time should be accurate within 2 minutes. If you do not know your exact birth time, you may wish to have your birth time rectified (see Rectification). 
o	The Jyotishi asks you to give certain personal information about yourself - e.g., male or female, married or single, parents are living or deceased, number of children, and so on. This information will verify the correctness of the astrological chart prepared using your birth data. 
o	Include a return e-mail address so that we can acknowledge your order. Also, if the astrologer requires further information, we will contact you by e-mail. 
o	Specify type of payment (check, money order, or credit card). Checks and money orders must be payable in US dollars.

Mailing Information 
Name (First, MI, Last): __________________________________________________ 
Street address: ________________________________________Apt:____________ 
City: ________________________________State: ___________Zip: ___________ 
Country: ____________________________________
Phone: (_______)_______________ E-mail address: ___________________________ 
Have you had a Jyotish horoscope from Vedlink before? Yes / No (Circle one)
Birth Information 

Date of Birth (Month/Day/Year): ______________________________________ 
(Please spell out the month & date; e.g., April 3, 1967; September 19, 1938)

Exact Time of Birth (Hours/Minutes ): _____________AM or PM ?_______ (e.g., 9:06 PM) 
From birth certificate, mother, family records, other (Circle one) 

Rectify Birth Time? Yes / No (Circle One) (for details see Rectification)

Time Zone (if known): ___________________________ (e.g., Pacific Daylight Time) 

Place of Birth / City: __________________________ State: _________________ 

Country: ____________________________________

Longitude (if known): ___________________________ (e.g., W 123 deg 04 min) 

Latitude (if known): _____________________________ (e.g., N 44 deg 05 min) 
Personal Information 
The following information will help the Jyotish astrologer verify the correctness of the birth information: 
Male / Female (Circle one) 

Married / Single / Separated / Divorced / Widowed (Circle one) 

Number of children (e.g., 1 son, 2 daughters): 

______________________________________________________________ 

Profession/Occupation:

______________________________________________________________ 

Education:

_______________________________________________________________ 
Mother Living: Yes / No (Circle one)

Father Living: Yes / No (Circle one)

Number of Siblings (e.g., 1 sister, 2 brothers): 
________________________________________________________________ 
Please describe any body marks you may have, such as a birthmark, mole, scar, etc. 
(I have a scar on my right forearm. I have a small oval birthmark on my shoulder.) 
________________________________________________________________ 

Please give dates of 2 significant events in your life ( I was married on May 4, 1978; My first child was born on August 10, 1981.). Note: If your birth time is to be rectified, give exact dates for 6 events.
1. 
2. 

(Give 4 additional events if birth time is to be rectified.) 

3. 
4.
5.
6.

Payment Information 
___ I wish to order a written Jyotish horoscope: INR 10,000/- (for Natives living in INDIA) or US$ 200

___ I wish to have my birth time rectified: INR 5000/- (for Natives living in INDIA) or US$ 100(optional). 
  Total Amount: _______________ 
For Paypal our Account is “consultancy@paramhansa.com”
For UPI (Unified Payments Interface) :- ParamHansa@UPI or msnegi@upi

Payment   through RTGS/ NEFT/ Net Banking for Details, eMail to Acharya@paramhansa.com   

Please allow 10 - 14 days for completion of your horoscope. Please indicate how you would like the report sent to you: 
  
___ E-mail.......to this e-mail address: ____________________________________________ 
( Please print legibly. Even slight errors will prevent transmission of e-mail. )
Please Note: 
A Jyotish astrological horoscope is the opinion of one person based on his or her training and experience in Vedic astrology. Another astrologer's opinion on any particular point may differ. The horoscope you receive should not be used as a substitute for advice, programs, or treatment that you would normally receive from a licensed professional, such as a lawyer, doctor, psychiatrist, or financial advisor. Paramhansa, Inc. makes no warranties or representations regarding the accuracy or significance of any aspect of the astrological horoscope, and cannot be responsible for any interpretation or use that may be made of it. 

E-Mail: Acharya@paramhansa.com