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To Schedule a Consultation or Request
a Service
You will be contacted, via e-Mail (or phone,
local clients) as soon as possible
with potential consultation dates and times.
Please complete the form below.
Tel: 514-684-7167
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First
Name
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Last
Name
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Full
Name at Birth (if different from above)
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E-mail
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Telephone
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Preferred
consultation time
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Daytime
Evening |
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Location
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In Person
By phone |
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Service
Requested
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Click
here for an Electional Chart.
Click here for a Relationship
Analysis. |
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How
did you hear about us?
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Friend
Internet
Networking Activity
Other
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Birth
Data
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Month
Day
Year
Time of Birth: Hrs
Min
A.M.
P.M.
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Place
of Birth (City, Town, Country)
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Current
place of residence (City, Country)
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Method
of payment
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Cash (In person)
Certified cheque (Phone, in person)
Paid by Paypal
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I
understand and accept that Pauline Edward and
A Time for Success are not to be held responsible
for any decisions that I may make subsequent to
the reception of information derived from a transit
or horary chart or from any consultation service.
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I
would like to receive your free e-letter Success
Matters
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YES! Sign me up for Success Matters.
No thanks, not at this time. |
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Special
questions, issues to be looked at (optional):
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