Change Credit Card Information

l Page 2 December 28, 2000

CHANGE CREDIT CARD INFORMATION

In order for you to change/update the credit card information for your account, you need to complete and fax this form to our corporate office @ 800-570-7696 (toll-free within the US) or 203-445-8154 (International).

Domain Name: _____________________________________

Current Credit Card Info:

Credit Card Number: ___________________________

Expiration Date (mm/yy): ___________________________

Name on Credit Card: ___________________________

New Credit Card Info:

Credit Card Number: ___________________________

Expiration Date (mm/yy): ___________________________

Name on Credit Card: ___________________________

Address 1: ___________________________

Address 2: ___________________________

State: ______________ Zip: ________

Country: ___________________________

Authorized Monthly Charge: ___________________________

I authorize OLM LLC (Online Marketing) to charge my MasterCard/VISA for payment towards monthly services as outlined in the order form for the above domain.

Card Holder's Signature: ___________________________

Print Card Holder's Name: ___________________________

If faxing the form is inconvenient, please mail the completed form to the address below.

By faxing/mailing this form, you are authorizing OLM to change/update the credit card information for the stated domain name and are agreeing to be liable for all fees/charges thereafter. In no event will OLM be liable for the non-payment of fees arising in connection with the submission of this form.