Printable Order Form

Please Print and Mail with Money Order, Personal Check (USA only), or well concealed cash to:
The Psychic Stratum
c/o Universal Ministries
PO Box 31
Milford, Illinois 60953 USA

Legal Information:
Required information is in red.

Credential Information:
(exact information you want on any credentials,
if different from legal info)
You may specify up to 3 lines for ID cards.
1st and 2nd lines may have 27 characters each,
3rd line may have 30 characters.
Certificates and degrees require name only.

Specify here if shipping info is different:

If paying by credit card:
Circle One:	Visa / MC / AmEx / Disc
Credit Card #:
Expiration Date:
CVC # (if available)

Full Legal Name:
Address:
City:
State or Province:
Zip or Postal Code:
Country:
Birthdate:
Phone:
Email:

Items You Would Like to Order: (Please describe accurately) If you need more lines, just print off another form.
Donation:





Please add: $2.95 for a single certificate, or $5.95 for a package.	Shipping:
	Total:

Do not write in this box.
For office use only.