    LIFECYCLE FERTILITY PREDICTOR ORDER FORM

You can order LifeCycle Fertility Predictor via mail
or fax using this order form.  Please fill it out in
its entirety.  If you provide an e-mail address, we
will e-mail your order confirmation and your regis-
tration password.  

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


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SHIPPING INFORMATION

Name: ________________________________________________

Street Address: ______________________________________
                     (no P.O. boxes accepted!)

City, State, Zip: ____________________________________

E-mail: ______________________________________________

Phone: _______________________________________________


PURCHASE INFORMATION

Product                  Qty   x   Price  =  Extension
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LifeCycle Registration   ____      34.95     _________

Basal Thermomters:

     B-D Digital         ____      18.95     _________

     Ovulindex Mercury   ____      12.95     _________


                                Subtotal     _________

         VA residents add 4.5% sales tax     _________

                         Handling charge         3.95

                                   Total     _________

PAYMENT INFORMATION

        Circle one:    Visa  /  Mastercard  /  Check
        (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!