| AURA READING BY LORETTA MARIE MAIL ORDER FORM |
ORDERING INSTRUCTIONS:
Print Out Mail Order Form then Fill in All Pertinent Information!
Today's Date: ________________________
I Have Enclosed a Recent Color Photograph of the Person/Pet Receiving the Aura Reading: Yes____
I Give Loretta Marie Permission to Conduct an Aura Reading: Yes________
Please Choose One:
Email My Information: Yes___ No___ Send My Information Through the U.S. Mail: Yes__ No____
Paying By: (check one)
Money Order_____ Cashier Check_____ Personal Check_____ Credit/Debit Card_____
Amount Enclosed: $________________________________
Paying By Check or Money Order:
Make Cashier Check, Personal Check or Money Order Payable to The Inner Light Shoppe
Paying by Credit/Debit Card:
Type of Credit/Debit Card: Visa_____ MasterCard____ American Express___ Discover Card____
Name on Credit//Debit Card:_____________________________________________________________________________
Credit/Debit Card Number:______________________________________________________________________________
Expiration Date: ______________________ Security Code (last 3-Digits on Back of Card): ______________
Amount Charging to Credit/Debit Card: $____________________________
Signature of Person on Card:___________________________________________________________________________
Billing Information:
Name:
_________________________________________________________________________________________________________________________
Address: ______________________________________________________________________________________________________________________
City: _______________________________________________________________ State:_______________ Zip Code: _________________________
Email Address: ______________________________________________________________________________________________________________
Day Telephone #:_________________________________________________________ Night Telephone #: ______________________________
Ship To: (Only if Different Than Bill To Address):
Name: ________________________________________________________________________________________________________________________
Address: _____________________________________________________________________________________________________________________
City: _____________________________________________________________________ State: __________________ Zip Code: _______________
Send Completed Mail Order Form and Payment To:
Spiritual Consultations by Loretta Marie
P.O. Box 214988
Auburn Hills, MI 48326
Upon receipt of your color photograph and payment, the information you requested will be sent within 24 to 48 hours
(Email) and depending on your location you should receive your Aura Reading within 7-10 days (U.S. Mail).
Note: You must be at least 18 years old to have a reading. All Aura Readings are conducted for Entertainment
Purposes Only.
Print Out Mail Order Form then Fill in All Pertinent Information!
Today's Date: ________________________
I Have Enclosed a Recent Color Photograph of the Person/Pet Receiving the Aura Reading: Yes____
I Give Loretta Marie Permission to Conduct an Aura Reading: Yes________
Please Choose One:
Email My Information: Yes___ No___ Send My Information Through the U.S. Mail: Yes__ No____
Paying By: (check one)
Money Order_____ Cashier Check_____ Personal Check_____ Credit/Debit Card_____
Amount Enclosed: $________________________________
Paying By Check or Money Order:
Make Cashier Check, Personal Check or Money Order Payable to The Inner Light Shoppe
Paying by Credit/Debit Card:
Type of Credit/Debit Card: Visa_____ MasterCard____ American Express___ Discover Card____
Name on Credit//Debit Card:_____________________________________________________________________________
Credit/Debit Card Number:______________________________________________________________________________
Expiration Date: ______________________ Security Code (last 3-Digits on Back of Card): ______________
Amount Charging to Credit/Debit Card: $____________________________
Signature of Person on Card:___________________________________________________________________________
Billing Information:
Name:
_________________________________________________________________________________________________________________________
Address: ______________________________________________________________________________________________________________________
City: _______________________________________________________________ State:_______________ Zip Code: _________________________
Email Address: ______________________________________________________________________________________________________________
Day Telephone #:_________________________________________________________ Night Telephone #: ______________________________
Ship To: (Only if Different Than Bill To Address):
Name: ________________________________________________________________________________________________________________________
Address: _____________________________________________________________________________________________________________________
City: _____________________________________________________________________ State: __________________ Zip Code: _______________
Send Completed Mail Order Form and Payment To:
Spiritual Consultations by Loretta Marie
P.O. Box 214988
Auburn Hills, MI 48326
Upon receipt of your color photograph and payment, the information you requested will be sent within 24 to 48 hours
(Email) and depending on your location you should receive your Aura Reading within 7-10 days (U.S. Mail).
Note: You must be at least 18 years old to have a reading. All Aura Readings are conducted for Entertainment
Purposes Only.
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| All Rights Reserved Copyright 2012, Spiritual Consultations by Loretta Marie |
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