ACCOUNT ORDER FORM

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Web Hosting $300.00 (Pre-paid 1 Yr in Advance) .................................... $       .
Web Page Hosting $119.40 (Pre-paid 1 Yr in Advance) ........................... $       .
Additional fees .............................................................................................$            
                                                                                                         TOTAL $       .
All currencies are in US Dollars

Domain Name registration fees ($70.00 for the first two years) will be billed directly from InterNIC

DOMAIN NAME:

Domain Name Hosting:  www.                                     

Web Page Hosting:  www.mannygeller.com/               

CONTACT INFO:

Company Name _________________________________________
First Name          _________________________________________
Last Name          _________________________________________
Address               _________________________________________
City                     _______________________________ State _____
Zip/Postal Code _______________
Country              _________________________ Country Code ____
Phone                (____) ____-______
Fax                    (____) ____-______

*Email Address [________________________________________]

     *REQUIRED - Account Information will be mailed to this address

**Please choose your FTP account password [___________]

              - Must be at least 2 characters and no more than 8
              - Passwords are case-sensitive (PassWOrd is not the same as password)

     **REQUIRED - For Domain Hosting Service

Signature of person filling out form: _________________________________________ ( Indicates the acceptance of Term & Conditions )

Make Check or Money Order payable to Manny Geller
WebHosting

Prices subjects to change without notice.

52305

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MannyGeller. COM, INC.
920 N.E. 199th Street - 311
Miami, FL 33179