The Solar System

Astrology Reading Form

If you have ordered your astrology reading using Paypal, then please complete this form and submit it to Maxine. If you prefer to email or speak to Maxine first, please see the contact page.

A text box has been provided at the end of the form for any notes or questions you may want to include.

  • READING(S) SELECTED

  • Select the reading(s) you would like to order:

    Maxine's current discounted special will be in purple.
  • CONTACT INFO

  • REFERRAL SOURCE

  • Your contact information

    Please provide the email address where you would like the reading video download link sent.
  • FIRST PERSON'S BIRTH INFO

  • First individual's birth information

    Enter your or the first person's birth information.
  • Please ensure date of birth has correct month, day & year
    Date Format: MM slash DD slash YYYY
  • :
  • SECOND PERSON'S BIRTH INFO

  • Second individual's birth information

    Enter the second person's birth information if applicable.
  • Is this individual's information to be used for a chart comparison with the first individual?
  • Date Format: MM slash DD slash YYYY
  • :
  • QUESTIONS

  • Questions or areas of focus for your reading

    Please list any specific areas of interest you would like Maxine to review in your reading.
  • This field is for validation purposes and should be left unchanged.