Custom Jyotish Services

Request Form

This form if for persons who want some special customized service that is not found on our list of services. You should first discuss this issue with me so that we can estimate the cost etc. If anything is unclear or you have questions please contact me. Please be sure to include your email address in the appropriate space, without it we cannot contact you.

In order to protect you from credit card fraud we are recording your IP address for security purposes.

Your IP address:

I want a customized jyotish service ($400/hr):

Rush my order (add $100):

The answer will be sent to you via email.
Your email address:

Special Topics: Any special topics you want the astrologer to discuss in your reading? Don't be shy. If what you ask is not possible or not applicable to that type of reading we will tell you, but it never hurts to ask. But, please do not mention what other readers may have said, otherwise it may bias me.

 

Comments: How did you hear about this site? Any comments or suggestions regarding this site or our services.


Data required for this reading.

If more than one person is involved you can include their birth data in the "Special topics" area above. But, please be sure to spell out the name of the month of birth to avoid confusion as there are many dating conventions currently prevalent.

First Name:
Last Name:
Initial:
Name at birth if different from above:
Sex:
 Male Female
Birth Data:
 Please note that if the time or date of birth are unknown or inaccurate then we will have to rectify the chart.
Date of Birth:
 Day Month Yr
Time of Birth:
 Hours Minutes (military time)
Source of birth time (hospital record, birth certificate, mother's memory, other)
Place of Birth:
City:
State/Province:
Country:
If born in a small village give the name of the nearest town and approximate distance:
Nearest large town:
Distance from birth place:
 in miles.



Payment Method: card type



First name:
Last name:
Initial:
Account number: (no spaces)
Expiration date: Month Year
Card Verification Number What is that?
Amount:
Billing address:
Apt #:
City:
State/Province:
Country:
Zip/Postal Code:
Telephone:
Country Code:

Check all birth data. Please read
the following carefully.

Have you included your email address as requested at the beginning of this form? We need it to contact you.

Before submitting this form please review all the information you have provided especially your birth data. We assume that the information you provide is correct. Errors or mistakes in this regard are your responsibility. If the chart has to be done again because you gave wrong data it will be done as new chart at full price. So get it right the first time.

Also please note that when you submit this form it is not automatically processed. Why is that important to you? Because that means that your card will not be automatically debited, in other words you will not be charged until after the work is done, however a pre-authorization will be done just before commencing the work to lock in the funds.

To recognise the transaction on your credit card statement the billing descriptor will be "Shyamasundara Dasa."

By checking the box I affirm that have read the terms of service and agree to be bound by them.

To authorize please type "I agree" here: