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S. A. PETULLO CORPORATE ORDER & CONTACT INFORMATION FORM

Please print this form and fax or send completed form, along with handwriting sample(s) and other requested completed forms to S. A. Petullo Corporation 1489 Steele St. Unit # 105 Denver, CO 80206

Phone: 303.355.3805 Fax: 303.398.4767 www.scottpetullo.com

Today’s date: ______________

Return analysis to the attention of: __________________________________________

Title: _________________________________

Email address: _________________________________________________

Phone: ______________________________________________________

Fax: __________________________ (__To ensure confidentiality, please check here if it is necessary to call before faxing)

Address: _______________________________________________________________________________________

City, state, ZIP code: __________________________________________________________________________________

Please select desired options below.

Corporate Handwriting Analysis Options: __#1 Comprehensive Profile Analysis __#2 Verbal Comprehensive Profile Analysis __#3 Profile Analysis __#4 Custom Profile Analysis __#5 Compatibility Analysis __#6 Custom Mini Profile Analysis __#7 Reliability and Confidentiality Evaluation __#8 Brief Analysis __#9 Career Compatibility and Assistance Guide __#10 Additional Consulting __#11 Rush Service for Options #1, #2, #3, and #4 __#12 Rush Service for Options #5, #6, #7, #8, and #9.

Corporate Numerology/Astrology Analysis Options: __#1 Second Opinion Reading __#2 Numerology/Astrology General Compatibility __#3 Group Analysis __2, 3 or 4 people __5-10 people __#4 Numerology/Astrology Analysis __Other.

Subject’s name: _______________________________________________________________________________________

Date of first contact: ___________________________

Date of first interview: __________________________________

*New applicant___ Current employee___ Current employee promotion___ Self___

Other (please explain): _____________________________________________________________________________________

Job title: ______________________________________________________________________________________

Reports to: _______________________________________________________________________________________

Job title: ________________________________________________________________________________________

**Description of job duties: ________________________________________________________________________________________

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*Please supply completed S. A. Petullo/Client release form and a copy of the subject’s resume.

**Please supply completed S. A. Petullo Job Demands Checklist and a copy of the job description. The Job Demands Checklist is necessary to complete each analysis.

For those times when obtaining the subject’s full birth data is illegal or impossible. Subject’s month and day of birth:

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Asterisked (*) information below necessary for comprehensive numerology/astrology analyses.

*Subject’s full, legal birth name (exactly as it is on the original birth certificate):

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*Month, day, year, exact time and location of birth (state “approximate” if you don’t know exact time):

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*Please list all birth data for other people involved, such as for a compatibility or group analysis (current name, full legal birth name, full date of birth, exact time, and location of birth):

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*List the date and approximate time you first met the person in question (for compatibility analyses, etc.), or date and time you first had the idea, started the project, incorporated the business, signed the contract, etc:

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Please state what you want in a consultation, the key issues to be addressed, and your related concerns. Love life? Compatibility? Career? Money? Family? Event Timing? Forecast?:

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Indicate several dates and times when you are available to have the consultation (if not email analysis/reading or faxed profile):

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