Leon Bracelin
psychic medium visionary & astrologer

Detailed Yearly Forecast Order Form
Please print clearly

Name ..................................................................................................

Address ................................................................................................

Town....................................................................................................

County..................................................................................................

Postcode................................................................................................

Telephone Number (please include code)....................................................

Mobile Number..................................................


In order to build your chart we require further informaton

Age................

Sex................

Date of Birth......................................

Time of Birth......................................

Location of Birth...................................................................

Please check all fields are filled in accurately.

Please print out and send this form with payment of £75 payable by cheque to:
Leon Bracelin, The Gallery Studio, Linney, Ludlow, Shrophire, SY8 1ED

Please allow up to 2-4 weeks delivery or make a special request on 01584 873447
If you require further information please contact Leon directly with the contact
details below.

Contact information
Work: 01584 873447    Mobile: 07969637022