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Vedic Horoscope and Remedies - Order Form

Fill the following form carefully.
When you Submit the Form, you will be forwarded to Secure payment page.

Full Name of the Person
Email
Gender (Male/Female)
Marital Status (Married/Single/Divorced)
Profession
Father's Name
Mother's Name
No. of Children, if any (Sons & Daughters separately)
Birth details of the Person (Date*, Time, Place of birth)
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Date to be mentioned in the same Format as in 1st January 1975.
Details of problems for which Remedies are sought

 
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