①Your first name：
②Your last name：
③Your nick name：
④Your mail address：

※Only those who can not write your real names due to unavoidable circumstances, please write your nick name.

⑤Your Skype ID：
⑥Your Sex：
⑦Your date of birth：
⑧His/Her first name：
⑨His/Her last name：
⑩His/Her date of birth：
⑪His/Her nick name：

※For His/Her first name, His/Her last name, His/Her date of birth,I would be grateful if you could write down if you would like us to divine your loved one, family, working companion, boss and subordinate.

※Only those who can not write his/her real names due to unavoidable circumstances, please write his/her nick name.

⑫Divination menu：

a.Email Divination
b.Phone Divination
c.Business Divination
d.Face to Face Divination

※Divination menu has mail Divination, Phone Divination, Business Divination, Face to Face Divination.Please choose either.

⑬Please write the date and time you would like us to divine.：

※ Please write when you choose Phone Divination, Business Divination, Face to Face Divination here.

⑭Please write down your consultation content. ：

⑮Please select the cover type of divination book from the following contents.：

a.Gold ver.
b.Green ver.
c.Orange ver.
d.Pink ver.
e.Blue ver.
f.Leave it to JUNKA∞AKITOKIMI ver.

⑯About the results of divination, Please choose either.：

a.PDF divination book
b.I wish to have the results of divination written directly in the mail

Please choose whether you would like a PDF divination book or wish to have the results of divination written directly in the mail.

Please select only one who chose 【Email Divination】.