Biorhythm Order Form

Full Name

Address

City

VISA

Your Birthday

State

Zipcode

Expires

Yes! Send me the free book, Your Goldmine is Your Gold Mind. I have enclosed the shipping and handling fee of $3.50

To order your Biorhythm chart, plus your unique personal guide, print out this form and fill it out. Please send check, money order or provide credit card information, plus your date of birth. You can also fax us the form with credit card information for processing today.

Send $5.00 for 30-day chart and guide.
Send $7.50 for 90-day chart and guide.
You may order a comparative chart and guide for friend(s) simply by supplying their name, date of birth, and proper fee.

Send Order form and payment to :
BIORHYTHM
P.O. Box 655
Pottsville, AR 72858

Fax : (501) 498-2242

Voice Phone : (501) 967-5132

Allow 3-5 days for processing