\input tex
\twelvepointsanserif
\parskip=4pt
\def\pfill{\null\nobreak\leaders\hrule%
    \hskip10pt plus1filll\ \par}
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{\seventeenpointsanserif
    \centerline{\bf ASTROLOGICAL INFORMATION}
    \centerline{\bf QUESTIONNAIRE}
}
\smallskip
We need the information below to complete your astrological chart. For¨
one chart, fill out the section on the left. For two charts or the¨
compatibility chart, fill out both sides.

{\bf Time of birth:} The more accurate the birth time you give us, the¨
more accurate the chart we can give you. If you aren't sure of the¨
exact time, make a good guess. If birth time is unknown, we can still¨
generate a chart using the Rectification Process, though it is less¨
accurate. 

{\bf Place of birth:} From the place of birth you give us, we¨
calculate Latitude and Longitude, the exact position on the Earth.¨
(Our charts are accurate to 5 minutes-of-angle.) Because many small¨
cities and towns do not show up in our maps and listings, please¨
include the name of the nearest large city. {\bf If we cannot locate¨
your birth place, we cannot complete your chart}. The more information¨
you give us the better the chart we give you. All information is¨
strictly confidential.

\bigskip

\begindoublecolumns

{\bf Required Birth Information}\par
Name to appear on chart:\enspace\pfill
Place of birth:\enspace\pfill
\quad Nearest large city:\enspace\pfill
\quad How far away?\enspace\pfill
State or Region:\enspace\pfill
Country:\enspace\pfill
\vskip\parskip
\halign{
#\quad\hfill&%
\hfil#\fillin&%
\hfil#\fillin&%
\hfil#\fillin\cr
Birth date:& Year& Month& Day\cr
Birth time:& Hour& Minute& AM/PM\cr
  &Exact& &\hidewidth Within 1 Hour\cr
  &\hidewidth Unknown& &\hidewidth Within 6 hours\cr
}
\vfil\goodbreak
{\bf Compatibility Charts} or {\bf Additional Charts}\par
Name to appear on chart:\enspace\pfill
Place of birth:\enspace\pfill
\quad Nearest large city:\enspace\pfill
\quad How far away?\enspace\pfill
State or Region:\enspace\pfill
Country:\enspace\pfill
\vskip\parskip
\halign{
#\quad\hfill&%
\hfill#\fillin&%
\hfill#\fillin&%
\hfill#\fillin\cr
Birth date:& Year& Month& Day\cr
Birth time:& Hour& Minute& AM/PM\cr
  &Exact& &\hidewidth Within 1 Hour\cr
  &\hidewidth Unknown& &\hidewidth Within 6 hours\cr
}
\enddoublecolumns

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\dottedline
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\centerline{\seventeenpointsanserif\bf ORDERING INFORMATION}
\medskip
\begindoublecolumns

Complete this form and mail it with your payment to the address¨
below. You will receive your charts within two weeks.

\vskip\parskip
\lline{\qquad AstroTek}\nobreak
\lline{\qquad Box 77731}\nobreak
\lline{\qquad San Francisco}\nobreak
\lline{\qquad CA 94107}

\vfill\goodbreak
\line{One complete Astrological Chart\leaderfill\ \$15}
\line{Two complete Astrological Charts\leaderfill\ \$25}
\line{Two complete Astrological Charts,\hfill}
\line{\quad plus Compatiblity Chart\leaderfill\ \$35}
\line{Total\leaderfill\fillin}
\enddoublecolumns

\bigskip

\begindoublecolumns
{\bf CONFIDENTIALITY}: All information on this order¨
form/questionnaire is confidential. Our mailing list is for us to¨
contact you only, to keep you informed of services available from us¨
now and in the future. Once we generate your charts and put them in¨
the mail to you, all personal information except your address is¨
discarded. We do not give or sell any information to anyone else.

If you do not wish to be on our mailing list at all, enter ``NO''¨
here:\enskip\fillin\par

\vfill\goodbreak

{\bf YOUR MAILING ADDRESS:}\par
Name:\enskip\pfill
Street Address or PO Box:\enskip\pfill
City, State, ZIP CODE:\enskip\pfill
\enddoublecolumns

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\supereject\end