Maharajajewel.com ●Remedial Vedic Prescription Gemstones and Jewelry●

Based on our promotional offer, you will be provided with ONE gemstone prescription for $39.99  Please provide the following information. All required fields are in the font color red to calculate and prescribe your most powerful life enhancing Gemstone.

 

First Name

Last Name

Organization

Street Address

Address (cont.)

City

State/Province

Zip/Postal Code

Country

 Phone

Cell Phone

FAX

E-mail

          Enter the date of birth:

-- mm/dd/yyyy

        Enter the time of birth:

-- hh:mm am/pm

          How accurate is time of birth (1=stated from birth certificate, 3 = time based on memory):

1
2
3

          Enter your place of birth (City/State/Country):

SERVICE OPTION 1:

This is a prescription of of one gemstone out of a possible four. Here, you will have the opportunity to chose which area you would like to know more about and would like to change. For our $39.99 (a $49.99 value) prescription, you may have only one choice.

OR

SERVICE OPTION 2:

To receive prescriptions for gemstones that address all vital arenas, please chose from below. You will receive our premium service which includes a total prescription of which gemstones are beneficial and which ones should be avoided. Also included is a detailed analysis from our GIA certified Vedic gemologist, Niranjan Mehta. These gemstones will provide a total tune-up of your cosmic energies. You get all this and life long benefits for only $59 (a $79 value).

          Credit Card: (As this site is NOT secure you may fax your credit card information to 707-869-1563).

          Expiration date:

-mm/yy

          Are you wearing any gemstones currently? If so, which ones?

          How did you find out about our service:

     

          How do you like our website? Please express your views and recommendations about our content.

          Please redeem your discount here by entering the coupon number:

By: Riddhi Mehta   
Copyright © 2004 [Maharajajewel.com]. All rights reserved.
Revised: 06/25/07