Full
Name: Where
do you live (city & country): Email
address: Confirm
email address: Date
of birth (DD/MM/YYYY) : Marital
status: Please
choose single - but in
a relationship single -
and in no relationship married divorced widowed Client
status: Please
choose I
am a new customer, this is my first purchase here I
am an existing customer, I have purchased here before Payment
method: Please
choose Just paid via PayPal I
will pay via bank transfer into UK bank I
will make a cash payment at a Halifax branch I
am using a Gift Voucher Should
you use a gift voucher as full or part payment, please quote your gift voucher
code: Ordered
counselling: Please
choose classical
(psychological) counselling spiritual
counselling Ordered
time package: Please
choose 1 hr by phone/skype 2
hrs by phone/skype 3 hrs by phone/skype 4
hrs by phone/skype 5 hrs by phone/skype For
counselling by phone, please state your phone number/s, so we can check For
counselling via skype, Please
suggest your preferential What
is the reason for the counselling? For
spiritual counselling cards, angels, astrology will be used as well, so for
Eva to also have a look at astrological charts during the counselling, Place
of Birth (town & country): Time
of Birth: If
your situation involve/s any other person/s, please also state their DOB, time
of birth and place of birth (city & country): It
would help us to know, where you heard about our services. Would
you like to keep informed about special offers or news? Yes No Any
other information you would like to give us? Many
thanks.
After
the receipt of your payment & the receipt of this form,
to arrange a convenient time for the counselling.
About
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