AmritaPuja.org Printable Puja Request

CREDIT CARD PAYMENTS (Click here to pay online with a credit card.)
Please fill out the from below, printi it, and fax it to us at:
M. A. Center, fax: 1-510-743-PUJA(7852).

CHECK OR MONEY ORDER PAYMENTS
Please fill out the form below, print it, and mail it to:
M. A. Center, P.O. Box 613, San Ramon, CA , 94583

QUESTIONS?
Please call M.A. Center at 1-510-537-9417, ext. 121 (or leave us a message at ext. 481)
or E-mail: puja@amma.org.

PLEASE READ THIS FOR ALL PUJA REQUESTS:

  • All payments must be in U.S. dollars.
  • To request a puja for a specific day, please be sure we receive your request two weeks before your requested Puja date(s).
  • Due to the high volume of puja requests, unless requested, we do not send a confirmation. The prasad you receive from India will serve as confirmation of the completion of the puja.
  • Please consult the vedic astrologer of your choice for auspicious dates.
  • Most pujas can be performed any day of the month, with the exception of the Kali Puja, which is performed on Amma's birthstar day each month.

PRINATBLE PUJA REQUEST FORM
YOU MAY REQUEST FROM ONE TO FIVE PUJAS USING THIS FORM
* Please mail this form and payment at least three weeks before your requested date(s).

PUJA 1            
Name   Birth Date
mm/dd/yyyy		   Birthstar (if known)   Requested
Puja Date*
     
Birth Place   Birth Time   Type of Puja   Cost $
 
am pm 		   
PUJA 2            
Name   Birth Date
mm/dd/yyyy		   Birthstar (if known)   Requested
Puja Date*
     
Birth Place   Birth Time   Type of Puja   Cost $
 
am pm 		   
PUJA 3            
Name   Birth Date
mm/dd/yyyy		   Birthstar (if known)   Requested
Puja Date*
     
Birth Place   Birth Time   Type of Puja   Cost $
 
am pm 		   
PUJA 4            
Name   Birth Date
mm/dd/yyyy		   Birthstar (if known)   Requested
Puja Date*
     
Birth Place   Birth Time   Type of Puja   Cost $
 
am pm 		   
PUJA 5            
Name   Birth Date
mm/dd/yyyy		   Birthstar (if known)   Requested
Puja Date*
     
Birth Place   Birth Time   Type of Puja   Cost $
 
am pm 		   
Total Cost of all Pujas $
CREDIT CARD PAYMENT        
Name as shown on card   Type of Card   Credit Card Number
NO SPACES OR DASHES 		  Exp. Date
(mm/yy)
  Visa
MasterCard		    
PAYER CONTACT INFORMATION        
First Name   Last Name   Daytime Phone    
       
E-mail       Street Address    
 
City   State   Country   Postal Code (Zip)
     
SEND PRASAD TO : (If different than above)
First Name   Last Name   Street Address    
   
City   State   Country   Postal Code (Zip)
     
PLEASE PRINT THIS PAGE USING YOUR BROWSER'S PRINT FUNCTION