Jyotish Reading Request Form

The following information will help us to accurately render your chart. Be assured that we respect your privacy and will hold your information in the strictest confidence!

Are you a current Padmini Light client? Yes   No

Today's date:             

Type of reading:         Life Reading, $140 Marriage Compatibility or Relationship Report, $65 Career Report, $45 Child Report, $35 Personalized Yearly Forecast, $65 Remedial Measures, $45 Timing of Auspicious Events, $25 Birth Nakshatra Reading, Free

Contact Information

Name:                          

Gender:                        Male     Female    

Street Address:        

City:                                State:  

Zip/Postal Code:                   Country: 

Home Phone:              Work Phone:

Cell Phone:                  Fax Phone:

Email Address:        

Birth Information

Date of Birth:(Date, Month, & Year)            

Birth Time:(AM or PM)                

Birth Time Source: Birth certificate Hospital records Family records Government records Other

Birth Place (City, State, Country):  

For Compatibility Reading Only—
2nd Person's Birth Information

Name:                          

Gender:                        Male     Female    

Date of Birth:           

Birth Time:               

Birth Time Source: Birth certificate Hospital records Family records Government records Other

Birth Place (City, State, Country):  

Payment Information

Mail a check made payable to Padmini Light to:

Padmini Light
7115 SW 179th Avenue
Aloha, OR 97007
USA

For credit card payment, please call 503.591.0984. A 5% service fee is required on credit card payments.