             HYPERCYCLES(tm) MAIL, FAX & E-MAIL Order Form 

Name (Please Print) ________________________________________________________

Address ____________________________________________________________________

City _________________________ State/Province ______________________________ 

ZIP/POSTAL CODE ___________________ Country  _______________________________ 

Phone#___________________________  FAX#_____________________________________

HYPERCYCLES (30 LEVELS):                         Method of Payment
[ ] HYPERCYCLES 3.5" Disks   $ 29.00     [ ] Mastercard   [ ] Discover 
[ ] HYPERCYCLES 5.25" Disks  $ 29.00     [ ] VISA         [ } Check
                                             
[ ] HYPERCYCLES Hat          $ 13.95      Card #____________________________
[ ] HYPERCYCLES T-Shirt      $ 13.95
    Select [S] [M] [L] [XL]               Expir. Date_______________________

SHIPPING CHARGES:              TOTALS:
[ ] USA & CANADA $ 5           Shipping and Handling charges: $____________
[ ] All other countries $10          
                              
   [For State of Indiana Residents Only (5%) State Sales Tax: $____________] 
                                             
                                             
                                             Amount enclosed: $____________

Make checks payable to ACLYPSE CORPORATION.  Allow 2 - 9 days for delivery.
Checks mailed to Aclypse must be drawn in US Dollars

Order by Phone 1-812-875-2852 (Voice Order Line) 

  Order by FAX 1-812-875-2836 (FAX Order Line) 

Order by Mail by writing to:     Aclypse Corporation
                                    Rt. 2 Box 213H
                            Worthington, IN 47471-9764  USA

Order by EMAIL to:      aclypse@iquest.net


Where did you get HYPERCYCLES Shareware Version from?

Downloaded from:
[ ]        BBS Named: ___________________________________________________
[ ]        CompuServe (CIS)
[ ]        America Online (AOL)
[ ]        Internet FTP Site: Site Name: ________________________________

Purchased from:
[ ]        Catalog Vendor: ______________________________________________
[ ]        From Aclypse
[ ]        Retail Store: ________________________________________________

Other:
[ ]        A friend gave it to me
[ ]        None of the above
[ ]        Unknown
