Reading Order Form
(Please print. Items in all CAPS are required.)

NAME:________________________________TELEPHONE:________________________

EMAIL ADDRESS:_____________________________Fax:________________________

PAYMENT METHOD:(Circle One) Mastercard - Visa - American Express - Discover - Check

CREDIT CARD NUMBER:______________________________EXPIRES:_____/______

SIGNATURE________________________________________DATE:_______________
        We require the following:
NAME AS APPEARS ON CARD:_____________________________________________
      BILLING ADDRESS 1:_____________________________________________
      MAILING ADDRESS 2:_____________________________________________(Required)
CITY:______________________STATE:_________ZIP/POSTAL CODE:__________

Select the items you desire.

Item                           Price         Selection

10 Minute Reading              $ 40.00          _____       
15 Minute Reading              $ 60.00          _____       
20 Minute Reading              $ 80.00          _____       
25 Minute Reading              $100.00          _____       

All prices are US dollars.

The following gift recipient information is required.

Name:___________________________________________

Address:________________________________________

State:__________________________ Zip:___________

Phone Number:___________________________________
Comments, Special Requests:

___________________________________________________________________

___________________________________________________________________

___________________________________________________________________

___________________________________________________________________
Print this form.   Sign and mail it to:
C&D Byrd Enterprises, Inc.
P.O. Box 3459
Cedar Hill, Texas 75106-3459
  or sign and fax it to:
888.371.3736
  The Company:
C&D Byrd Enterprises, Inc.
Cedar Hill, Texas
469.575.9000