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Text File  |  1995-06-24  |  2KB  |  61 lines
  1.              HYPERCYCLES(tm) MAIL, FAX & E-MAIL Order Form 
  2.  
  3. Name (Please Print) ________________________________________________________
  4.  
  5. Address ____________________________________________________________________
  6.  
  7. City _________________________ State/Province ______________________________ 
  8.  
  9. ZIP/POSTAL CODE ___________________ Country  _______________________________ 
  10.  
  11. Phone#___________________________  FAX#_____________________________________
  12.  
  13. HYPERCYCLES (30 LEVELS):                         Method of Payment
  14. [ ] HYPERCYCLES 3.5" Disks   $ 29.00     [ ] Mastercard   [ ] Discover 
  15. [ ] HYPERCYCLES 5.25" Disks  $ 29.00     [ ] VISA         [ } Check
  16.                                              
  17. [ ] HYPERCYCLES Hat          $ 13.95      Card #____________________________
  18. [ ] HYPERCYCLES T-Shirt      $ 13.95
  19.     Select [S] [M] [L] [XL]               Expir. Date_______________________
  20.  
  21. SHIPPING CHARGES:              TOTALS:
  22. [ ] USA & CANADA $ 5           Shipping and Handling charges: $____________
  23. [ ] All other countries $10          
  24.                               
  25.    [For State of Indiana Residents Only (5%) State Sales Tax: $____________] 
  26.                                              
  27.                                              
  28.                                              Amount enclosed: $____________
  29.  
  30. Make checks payable to ACLYPSE CORPORATION.  Allow 2 - 9 days for delivery.
  31. Checks mailed to Aclypse must be drawn in US Dollars
  32.  
  33. Order by Phone 1-812-875-2852 (Voice Order Line) 
  34.  
  35.   Order by FAX 1-812-875-2836 (FAX Order Line) 
  36.  
  37. Order by Mail by writing to:     Aclypse Corporation
  38.                                     Rt. 2 Box 213H
  39.                             Worthington, IN 47471-9764  USA
  40.  
  41. Order by EMAIL to:      aclypse@iquest.net
  42.  
  43.  
  44. Where did you get HYPERCYCLES Shareware Version from?
  45.  
  46. Downloaded from:
  47. [ ]        BBS Named: ___________________________________________________
  48. [ ]        CompuServe (CIS)
  49. [ ]        America Online (AOL)
  50. [ ]        Internet FTP Site: Site Name: ________________________________
  51.  
  52. Purchased from:
  53. [ ]        Catalog Vendor: ______________________________________________
  54. [ ]        From Aclypse
  55. [ ]        Retail Store: ________________________________________________
  56.  
  57. Other:
  58. [ ]        A friend gave it to me
  59. [ ]        None of the above
  60. [ ]        Unknown
  61.