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PRI#2221                                                 PSYCHIC RESOURCES, INC.                                 RECORD ALL CALLS

                                            
PSYCHIC NAME:   EXT#                                CALL DATE: 

 
Eastern CAll TIME:_________AM  PM   CALL LENGTH_________MINUTES  YES! ENROLL IN CLUB___ 
FIRST NAME:___________________________LAST NAME:____________________________________ 
ADDRESS:_________________________________________________SUITE/APT__________________ 
CITY:____________________________________________STATE:____________ZIP:_______________

BIRTHDATE:______________________________________

 
Eastern CAll TIME:_________AM  PM   CALL LENGTH_________MINUTES  YES! ENROLL IN CLUB___ 
FIRST NAME:___________________________LAST NAME:____________________________________ 
ADDRESS:_________________________________________________SUITE/APT__________________ 
CITY:____________________________________________STATE:____________ZIP:_______________

BIRTHDATE:______________________________________

 
Eastern CAll TIME:_________AM  PM   CALL LENGTH_________MINUTES  YES! ENROLL IN CLUB___ 
FIRST NAME:___________________________LAST NAME:____________________________________ 
ADDRESS:_________________________________________________SUITE/APT__________________ 
CITY:____________________________________________STATE:____________ZIP:_______________

BIRTHDATE:______________________________________

 
Eastern CAll TIME:_________AM  PM   CALL LENGTH_________MINUTES  YES! ENROLL IN CLUB___ 
FIRST NAME:___________________________LAST NAME:____________________________________ 
ADDRESS:_________________________________________________SUITE/APT__________________ 
CITY:____________________________________________STATE:____________ZIP:_______________

BIRTHDATE:______________________________________

 
Eastern CAll TIME:_________AM  PM   CALL LENGTH_________MINUTES  YES! ENROLL IN CLUB___ 

FIRST NAME:___________________________LAST NAME:____________________________________

ADDRESS:_________________________________________________SUITE/APT__________________ 

CITY:____________________________________________STATE:____________ZIP:_______________

BIRTHDATE:______________________________________

 
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