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ORDERFRM.TXT
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1999-04-29
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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.
------------------------------------------------------
SHIPPING INFORMATION
Name: ________________________________________________
Mailing Address: _____________________________________
City, State, Zip: ____________________________________
E-mail: ______________________________________________
Phone: _______________________________________________
PURCHASE INFORMATION
Product Qty x Price = Extension
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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!