LIFECYCLE FERTILITY PREDICTOR ORDER FORM

Print this out for postal or fax orders.  If ordering
the software only, diskettes or CDs will not be mailed.  
Shipping charges apply only to thermometer orders.  
International orders must provide payment in US funds 
drawn on US banks.

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SHIPPING INFORMATION

Name: ________________________________________________

Mailing Address: _____________________________________

City, State, Zip: ____________________________________

E-mail: ______________________________________________

Phone: _______________________________________________


PURCHASE INFORMATION

Product                  Qty   x   Price  =  Extension
------------------------------------------------------

LifeCycle Registration   ____      39.95     _________

Basal Thermomters (we only have access to Fahrenheit!)

     B-D Digital         ____      18.95     _________

     Ovulindex Mercury   ____      12.95     _________


                                Subtotal     _________

         VA residents add 4.5% sales tax     _________

                US/Canada shipping charge         4.95
                (thermometer orders only)

            International shipping charge         9.95
                (thermometer orders only)


                                   Total     _________

PAYMENT INFORMATION

Circle one:    Visa  /  Mastercard  /  Check / Money Order
      (Note: Fax orders must include credit card)

Name on Card: ________________________________________

Credit Card Number: __________________________________

Expiration Date: _____________________________________

Signature: ___________________________________________


MAIL / FAX TO:

	LifeCycle Software, LLC
	402 Dunham Massie Drive
	Hampton, VA  23669
	fax: 757-851-3793

Thank you!