To order PASUTILS by mail, please complete the following form 
and return it to:

     Daniel N. Leeks
     145-16 Arnold Drive
     West Lafayette, IN 47906

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               YES! I would like to purchase PASUTILS

      Name: ______________________________________________________

   Company: ______________________________________________________

   Address: ______________________________________________________

            ______________________________________________________

      City: _________________________ State: _____ Zip: __________
 
   Country: ______________________________________________________

 Telephone: ______________________________________________________

 I heard about PASUTILS from: ____________________________________


1. Indicate number of units below:

___  Copy(s) of PASUTILS.          X   $ 12.00         $__________
     
     + $3 shipping & handling 
      ($7.50 shipping & handling ouside U.S.)         $__________
     
                                                          ------------

                                             Total:    $ ________


Make a check or money order payable to Daniel N. Leeks




              * Please make payment in U.S. Dollars *
    Checks from foreign countries must be drawn on a U.S. Bank.