Don't Delay.   Acquire your New York City Virtual PresenceTM immediately by completing and submitting the following Agreement Form.  Or, if you prefer, call us at 1-800-669-6461 and we will fax or e-mail a copy to you.  In addition please also send us (by fax at 212.957.1912, or mail)  (i) a copy of the front and back of the credit card you intend to use in connection with your Presence and (ii) a copy of your drivers license or passport or any other photo identification card. Your Presence will begin on the date you indicate below or, if later, the date upon which we receive a copy of your credit card and photo identification card. NEW YORK CITY VIRTUAL PRESENCE AGREEMENT FORM BY COMPLETING AND SUBMITTING THIS AGREEMENT FORM YOU ARE BINDING YOURSELF TO  THE TERMS AND CONDITIONS OF OBTAINING A NEW YORK CITY VIRTUAL PRESENCE  YOU ARE AUTHORIZING CHARGES TO BE MADE TO YOUR CREDIT CARD IN ACCORDANCE WITH THAT AGREEMENT. The following form has 8 parts, 2 of which, relating to telephone services, are optional.  Before submitting this form, please make sure that at least the 6 required sections are completed and accurate. Part 1 [REQUIRED]: Terms and Conditions Certification I certify that I have read and agree to the terms and conditions relating to obtaining a New York City Virtual Presence. Part 2 [REQUIRED]: Basic Information Name Title Organization Street Address Address (cont.) City State/Province Zip/Postal Code Country Phone E-mail Part 3 [REQUIRED]: Start Date please indicate the month, date and year on which you wish services to begin.  (if that date is not the first day of a month, your first month's basic fees will be prorated based on the actual number of days in the month) Part 4 [REQUIRED]: Service Selections PLEASE SELECT ONE FROM THE FOLLOWING 8 CHOICES: The New York City Virtual Presence Solo : you can skip making any of the following selections if you intend to make any selections under PACKAGE SELECTIONS section below. Choice 1: I wish the The New York City Virtual Presence alone and not packaged with other services and, if indicated immediately below, the telephone services indicated (you may make telephone selections later, if you wish and you may change from the selection you make to any other selection at any time upon notice to us. Telephone services, if selected, will be included at an additional charge):  PACKAGE SELECTIONS: you can skip the following section on Package Selections if you selected The New York City Virtual Presence above. Please indicate the Package you desire by placing a check mark in the box provided by clicking your mouse in the box. Combination of Virtual Presence, 3 hours Conference Room Use and Telephone Services Choice 2: PACKAGE A ($175 per month)   A Manhattan mailing address and a shared fax number;  Mail and fax services; 3 hours of small or large conference room use per month. and discount rates for further use;  STANDARD Telephone Services* Choice 3:PACKAGE B ($195 per month)   A Manhattan mailing address and a shared fax number;  Mail and fax services; 3 hours of small or large conference room use per month. and discount rates for further use;  PREMIUM Telephone Services* * If you choose Standard or Premium Telephone Services, please fill provide the information near the end of this form telling us how you would like you calls answered and providing other needed information. Combination of Virtual Presence and 3 hours Conference Room Use Per Month and, if indicated below, the telephone services indicated, (you may make telephone selections later, if you wish and you may change from the selection you make to any other selection at any time upon notice to us.  Telephone services, if selected, will be included at an additional charge.): Choice 4:PACKAGE C ($169.95 per month or, if you qualify for the small, new or non-profit discount $139.95 per month)   A Manhattan mailing address and a shared fax number;  Mail and fax services; 3 hours of LARGE conference room use per month. and discount rates for further use. Choice 5:PACKAGE D ($139.95 per month or, if you qualify for the small, new or non-profit discount, $119.95 per month)   A Manhattan mailing address and a shared fax number;  Mail and fax services; 3 hours of SMALL conference room use per month. and discount rates for further use;  Combination of Virtual Presence and Your Guarantee of Conference Room Use Per Month and, if indicated below, the telephone services indicated (you may make telephone selections later, if you wish and you may change from the selection you make to any other selection at any time upon notice to us. Telephone services, if selected, will be included at an additional charge): Choice 6:PACKAGE E ($449.95 per month or, if you qualify for the small, new or non-profit discount, $419.95 per month)   A Manhattan mailing address and a shared fax number;  Mail and fax services; $400 of conference room use per month. and discount rates for further use. Choice 7: PACKAGE F ($359.95 per month or, if you qualify for the small, new or non-profit discount, $329.95 per month)   A Manhattan mailing address and a shared fax number;  Mail and fax services; $300 of conference room use per month. and discount rates for further use. Choice 8:PACKAGE G ($269.95 per month or, if you qualify for the small, new or non-profit discount, $229.95 per month)   A Manhattan mailing address and a shared fax number;  Mail and fax services; $200 of conference room use per month. and discount rates for further use. PART 5 [REQUIRED]: Status Certification (if applicable) I hereby certify that my business is a new business (operating 3 years or less) or a small business (having gross annual revenues of US$500,000 or less or a not-for-profit/charitable/NGO business.   PART 6 (OPTIONAL): Telephone Service Selections: Telephone services are entirely optional and selections may be made now or any time later. *Standard Telephone Services (($79.95 per month) *Premium Telephone Services ($99.95 per month) Voicemail attached to Standard Telephone Services $15 per month extra) Voicemail alone ($15.00 per month) plus excess usage charges, if any) Call Forwarding ($20.00 per month) plus time charges)** Call Forwarding attached to Standard or Premium Telephone Services ($15.00 per month) plus time charges)** Premium Call Forwarding attached to Standard or Premium Telephone Services ($20.00 per month) plus time charges)** * If you choose Standard or Premium Telephone Services, please fill provide the information near the end of this form telling us how you would like you calls answered and providing other needed information. ** If you select call forwarding, please indicate here to what number you wish the call forwarded.  Please include the area code and, if applicable, the country and city code/         PART 7 [REQUIRED]: Please Provide the following credit card information Credit Card Choose a card VISA MasterCard American Express Cardholder Name Card Number Expiration Date CVV2/CVC2 Number* *YOUR CVV2/CVC2 Number:  Visa and Mastercard, the three additional digits on the back of the card  printed on or just above the signature panel in reverse italics on the back of your card. Sometimes it is preceded by your card number. DO NOT CONFUSE THESE WITH THE LAST DIGITS OF YOUR CREDIT CARD NUMBER.  Amex cards, the four additional digits on the front of the card just above your credit card number PART 8 [OPTIONAL]: To be completed if (and only if) you have chosen Standard or Premium Telephone Services, please provide the following information telling us how you would like you calls answered and providing other needed information.  Otherwise please skip the following section. Firm Name: Contact Name: The Firm Name and Contact Name are pronounced like this: Fax Number: E-mail address: Answer my line like this: Here is the information I wish collected from my callers: Name    Address    Telephone Number    Other (please specify) Type of business or profession: Office hours (Monday-Friday) Office hours (Saturday) Office hours (Sunday) Send my messages to me: to my e-mail address         (US only) to my fax number Send me my messages at the following approximate New York City time (Monday or Friday) (Choose one) Here are some names callers may ask for: Here are some special instructions about calls: Here is some more information about me or my company: Thank you for acquiring a New York City Virtual Presence.  All that is left for you to do is to click on the SUBMIT button below.  This form has 7 parts, 2 of which, relating to telephone services, are optional. Before submitting this form, please make sure that at least the 5 required sections are completed and accurate. We will send you a welcome email shortly to confirm your New York City Virtual Presence and, if you have acquired any telephone services, to provide you with your 212 telephone number and related information.