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.

  • Maxine's current discounted special will be in teal.
    Please note that Maxine is no longer offering free birth charts due to the overwhelming response.

  • Your Contact Information

  • First Individual Birth Information

    Please enter your or the first individual's birth information below. If needed, Maxine will get your mailing address when she contacts you.
  • :

  • Second Individual Birth Information

    (if applicable)
  • Is this individual's information to be used for a Chart Comparison with the first individual?
  • :

  • This field is for validation purposes and should be left unchanged.