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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:______________________________________