Document:

Exhibit 4.3
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         THIS NOTE AND THE SECURITIES REPRESENTED HEREBY HAVE NOT BEEN
         REGISTERED UNDER THE SECURITIES ACT OF 1933, AS AMENDED, OR QUALIFIED
         UNDER APPLICABLE STATE SECURITIES LAWS AND HAVE BEEN TAKEN FOR
         INVESTMENT PURPOSES ONLY AND NOT WITH A VIEW TO OR FOR SALE IN
         CONNECTION WITH ANY DISTRIBUTION THEREOF. NEITHER THIS NOTE NOR THE
         SECURITIES REPRESENTED HEREBY MAY BE SOLD OR OTHERWISE TRANSFERRED IN
         THE ABSENCE OF SUCH REGISTRATION AND QUALIFICATION WITHOUT, EXCEPT
         UNDER CERTAIN SPECIFIC LIMITED CIRCUMSTANCES, AN OPINION OF COUNSEL FOR
         THE LENDER, REASONABLY ACCEPTABLE TO THE COMPANY, THAT SUCH
         REGISTRATION AND QUALIFICATION ARE NOT REQUIRED.

                               DELTA MUTUAL, INC.
                           CONVERTIBLE PROMISSORY NOTE

$                                                             September 20, 2004
                                                      Sellersville, Pennsylvania

      FOR VALUE RECEIVED, DELTA MUTUAL INC., a Delaware corporation (the
      "COMPANY"), with offices at 111 North Branch Street, Sellersville, PA
      18960, promises to pay to ____________________ (the "LENDER"), of
      ______________________, in lawful money of the United States of America,
      the principal sum of __________________Dollars ($), together with interest
      from the date of this Note on the unpaid principal balance at a rate equal
      to six percent (6.0%) per annum, computed on the basis of the actual
      number of days elapsed and a year of 365 days and compounded quarterly on
      the last day of each calendar quarter. All unpaid principal, together with
      any then unpaid and accrued interest and other amounts payable hereunder,
      shall be due and payable at any time after the earlier of (i) the Maturity
      Date (as defined below), or (ii) when, upon or after the occurrence of an
      Event of Default (as defined below), such amounts are declared due and
      payable by the Lender or made automatically due and payable in accordance
      with the terms hereof.

      The following is a statement of the rights of the Lender and the
conditions to which this Note is subject, and to which the Lender, by the
acceptance of this Note, agrees:

      (1) DEFINITIONS. As used in this Note, the following capitalized terms
have the following meanings:

         1.1 "COMMON STOCK" shall mean the common stock, par value $.0001 per
share, of Delta Mutual, Inc., a Delaware corporation.

         1.2 "COMPANY" includes the corporation initially executing this Note
and any Person which shall succeed to or assume the obligations of the Company
under this Note.

<PAGE>

      1.3 "COMPANY SALE" shall mean a merger or reorganization of the Company
with or into any other corporation or corporations, where the Company's
shareholders immediately prior to such transaction or transactions own
immediately after such transaction less than a majority of the voting equity
securities of the surviving corporation or its parent, or a sale of
substantially all of the assets of the Company.

      1.4 "EVENT OF DEFAULT" has the meaning given in Section 6 hereof.

      1.5 "LENDER" shall mean the Person specified in the introductory paragraph
of this Note or any Person who shall at the time be the registered holder of
this Note.

      1.6 "MATURITY DATE" shall mean September 16, 2006.

      1.7 "OBLIGATIONS" shall mean all obligations, owed by the Company to the
Lender, now existing or hereafter arising under or pursuant to the terms of this
Note.

      1.8 "OTHER NOTES" shall mean the other notes issued by the Company on the
same date as this note and with the same terms as provided by this Note, which
together with this Note, are in the aggregate principal amount of $301,500.

      1.9 "PERSON" shall mean and include an individual, a partnership, a
corporation (including a business trust), a joint stock the Company, a limited
liability the Company, an unincorporated association, a joint venture or other
entity or a governmental authority.

         (2) INTEREST. All accrued and unpaid interest on this Note shall be due
and payable on the Maturity Date.

         (3) SENIORITY. This Note shall be senior to all general obligations of
the Company including, trade payables and other obligations incurred in the
ordinary course of business.

         (4) REPAYMENT AT THE COMPANY'S OPTION. At any time prior to the
Maturity Date and upon thirty (30) days prior written notice to the Lender, the
Company may repay this Note, including all expenses due under this Note and all
interest accrued on this Note, without penalty or premium in whole or in part;
provided that any such repayment will be applied first to the payment of
expenses due under this Note, second to unpaid interest accrued on this Note and
third, to the payment of principal of this Note. Notwithstanding the foregoing,
upon receipt of such written notice and prior to the expiration of the
thirty-day notice period, the Lender shall have the right to convert this Note
in accordance herewith prior to any such repayment. At any time after the
Maturity Date and upon thirty (30) days prior written Notice to the Lender, the
Company may repay this Note, including all expenses due under this Note and all
accrued and unpaid interest, without penalty or premium in whole but not in
part, provided that prior to the expiration of the thirty-day notice period,
Lender shall have the right to convert this Note in accordance herewith prior to
any such repayment.

<PAGE>

         (5) REPRESENTATIONS AND WARRANTIES OF THE LENDER. The Lender represents
and warrants to the Company upon the acquisition of the Note as follows:

5.1 Binding Obligation. The Lender has full legal capacity, power and authority
to execute and deliver this Note and to perform its obligations hereunder. This
Note is a valid and binding obligation of the Lender, enforceable in accordance
with its terms, except as limited by bankruptcy, insolvency or other laws of
general application relating to or affecting the enforcement of creditors'
rights generally and general principles of equity.

5.2 Securities Law Compliance. The Lender has been advised that this Note has
not been registered under the Securities Act of 1933, as amended (the
"SECURITIES ACT"), or any state securities laws and, therefore, cannot be resold
unless it is registered under the Securities Act and applicable state securities
laws or unless an exemption from such registration requirements is available.
The Lender is aware that the Company is under no obligation to effect any such
registration with respect to this Note or to file for or comply with any
exemption from registration. The Lender is purchasing this Note for its own
account for investment, not as a nominee or agent, and not with a view to, or
for resale in connection with, the distribution thereof. The Lender has such
knowledge and experience in financial and business matters that the Lender is
capable of evaluating the merits and risks of such investment, is able to incur
a complete loss of such investment and is able to bear the economic risk of such
investment for an indefinite period of time.

         (6) EVENTS OF DEFAULT. The occurrence of any of the following shall
constitute an "EVENT OF DEFAULT" under this Note:

6.1 Failure to Pay. If the Note shall not have been converted pursuant to
Section 8 hereof, the Company shall fail to pay any principal or interest
payment or any other payment required under the terms of this Note on the date
due and such payment shall not have been made within fifteen (15) business days
of the Company's receipt of written notice from the Lender of such failure to
pay;

6.2 Failure to Comply With Covenants. The Company shall have failed to perform,
keep, or observe any other material term, provision, condition, covenant, or
agreement contained in this Note and has failed to cure such default within
fifteen (15) business days after the Company's receipt of written notice from
the Lender of such default;

6.3 Voluntary Bankruptcy or Insolvency Proceedings. The Company shall (i) apply
for or consent to the appointment of a receiver, trustee, liquidator or
custodian of itself or of all or a substantial part of its property, (ii) be
unable, or admit in writing its inability, to pay its debts generally as they
mature, (iii) make a general assignment for the benefit of its or any of its
creditors, (iv) be dissolved or liquidated, (v) become insolvent (as such term
may be defined or interpreted under any applicable statute), (vi) commence a
voluntary case or other proceeding seeking liquidation, reorganization or other
relief with respect to itself or its debts under any bankruptcy, insolvency or
other similar law now or hereafter in effect or consent to any such relief or to
the appointment of or taking possession of its property by any official in an
involuntary case or other proceeding commenced against it, or (vii) take any
action for the purpose of effecting any of the foregoing; or

<PAGE>

6.4 Involuntary Bankruptcy or Insolvency Proceedings. Proceedings for the
appointment of a receiver, trustee, liquidator or custodian of the Company or of
all or a substantial part of the property thereof, or an involuntary case or
other proceedings seeking liquidation, reorganization or other relief with
respect to the Company or the debts thereof under any bankruptcy, insolvency or
other similar law now or hereafter in effect shall be commenced and an order for
relief entered or such proceeding shall not be dismissed or discharged within
sixty (60) days of commencement.

         (7) RIGHTS OF THE LENDER UPON DEFAULT. Upon the occurrence or existence
of any Event of Default (other than an Event of Default referred to in Sections
6.3 and 6.4) and at any time thereafter during the continuance of such Event of
Default, the Lender may, by written notice to the Company, declare all
outstanding Obligations payable by the Company hereunder to be immediately due
and payable without presentment, demand, protest or any other notice of any
kind, all of which are hereby expressly waived. Upon the occurrence or existence
of any Event of Default described in Sections 6.3 and 6.4, immediately and
without notice, all outstanding Obligations payable by the Company hereunder
shall automatically become immediately due and payable, without presentment,
demand, protest or any other notice of any kind, all of which are hereby
expressly waived. In addition to the foregoing remedies, upon the occurrence or
existence of any Event of Default, the Lender may exercise any other right,
power or remedy otherwise permitted to it by law, either by suit in equity or by
action at law, or both.

         (8) CONVERSION AND ADJUSTMENTS TO CONVERSION PRICE.

8.1 Optional Conversion. At any time prior to the Maturity Date, the Lender may
convert all or any portion of the outstanding principal balance of this Note,
and, unless paid in cash by or on behalf of the Company, all accrued and unpaid
interest thereon, into fully paid and nonassessable shares of Common Stock. The
number of shares of Common Stock into which this Note may be converted (the
"CONVERSION SHARES") shall be determined by dividing the aggregate principal
amount, and, if applicable, accrued and unpaid interest, of the Note by the
Conversion Price (as defined below) in effect at the time of such conversion.
The "CONVERSION PRICE" shall be equal to $0.05 per share (subject to adjustment
for stock splits, combinations and other similar transactions).

8.2 Automatic Conversion. The outstanding principal balance of this Note and all
accrued and unpaid interest thereon shall be automatically converted upon the
occurrence of a Company Sale into fully paid and nonassessable shares of Common
Stock without any action by the Lender and whether or not the Note is
surrendered to the Company or its transfer agent. The Company shall not be
obligated to issue certificates evidencing the Conversion Shares upon a Company
Sale unless this Note is either delivered to the Company or its transfer agent,
or the Lender notifies the Company or its transfer agent that this Note has been
lost, stolen or destroyed and executes an agreement satisfactory to the Company
to indemnify the Company from any loss incurred by it in connection with this
Note. The number of Conversion Shares into which this Note shall be converted
upon a Company Sale shall be determined by dividing the aggregate principal
amount, and, if applicable, accrued and unpaid interest, of the Note by the
Conversion Price in effect at the time of such conversion. Such conversion shall
be deemed to have been made immediately prior to the close of business of the
date of closing of the Company Sale.

8.3 Fractional Shares; Effect of Conversion. No fractional shares shall be
issued upon conversion of this Note. Cash shall be paid to the Lender in lieu of
any fractional share. Upon conversion of this Note in full, the Company shall be
forever released from all its obligations and liabilities under this Note.

<PAGE>

8.4 Reservation of Stock Issuable Upon Conversion. The Company shall at all
times reserve and keep available out of its authorized but unissued shares of
Common Stock solely for the purpose of effecting the conversion of this Note
such number of its shares of Common Stock as shall from time to time be
sufficient to effect the conversion of the Note; and if at any time the number
of authorized but unissued shares of Common Stock shall not be sufficient to
effect the conversion of the entire outstanding principal amount and, if
applicable, accrued and unpaid interest, of the Note, without limitation of such
other remedies as shall be available to the Lender of this Note, the Company
will use its best efforts to take such corporate action as may, in the opinion
of counsel, be necessary to increase its authorized but unissued shares of
Common Stock to such number of shares as shall be sufficient for such purposes.

      8.5 Adjustmets to Conversion Price. The Conversion Price shall be subject
to adjustment in the following events:

         (i) In the event that the Company shall at any time subdivide the
outstanding securities into which this Note shall be convertible, or shall issue
a stock dividend on the securities into which this Note shall be convertible,
the number of Conversion Shares immediately prior to such subdivision or to the
issuance of such stock dividend shall be proportionately increased, and the
Conversion Price shall be proportionately decreased, and in the event that the
Company shall at any time combine the outstanding securities into which this
Note shall be convertible, the number of Conversion Shares immediately prior to
such combination shall be proportionately decreased, and the Conversion Price
shall be proportionately increased, effective at the close of business on the
date of such subdivision, stock dividend or combination, as the case may be.

<PAGE>

         (ii) In the event the Company, shall, at any time, from time to time,
issue or sell any shares of additional shares of common stock (otherwise than as
provided in the foregoing subsection (i) of this Section 8.5 or pursuant to
Common Stock Equivalents (hereafter defined) ("Additional Shares of Common
Stock"), at a price per share less than the Conversion Price then in effect or
without consideration, then the Conversion Price upon each such issuance shall
be reduced to a price equal to the consideration per share paid for such
Additional Shares of Common Stock. For purposes of this Note, the term
Additional Shares of Common Stock shall not include (1) the Company's issuance
of any securities for financing purposes (other than for cash) in connection
with a merger, acquisition or consolidation of the Company, (2) the Company's
issuance of securities for financing purposes in connection with strategic
license agreements and other partnering arrangements so long as such issuances
are not for the purpose of raising capital, (3) the Company's issuance of
securities for financing purposes in connection with bona fide firm underwritten
public offerings of its securities, (4) the Company's issuance of Common Stock
or the issuance or grants of options to purchase Common Stock pursuant to the
Company's stock option plans as they now exist, (5) as a result of the exercise
of options or warrants or conversion of convertible notes which are granted or
issued as of the date of this Note, (6) any Other Notes and the shares of Common
Stock issuable upon the conversion of such Notes, (7) the payment of any
interest on this Note or the Other Notes or (8) the sale or issuance of equity
securities to consultants and advisors and equity securities issued in private
fundraising transactions, not to exceed $300,000.

         (iii) If the Company, at any time after the date of this Note, shall
issue any securities convertible into or exchangeable for, directly or
indirectly, Common Stock ("Convertible Securities"), other than the Other Notes,
or any rights or warrants or options to purchase any such Common Stock or
Convertible Securities, shall be issued or sold (collectively, the "Common Stock
Equivalents") and the aggregate of the price per share for which Additional
Shares of Common Stock may be issuable thereafter pursuant to such Common Stock
Equivalent, plus the consideration received by the Company for issuance of such
Common Stock Equivalent divided by the number of shares of Common Stock issuable
pursuant to such Common Stock Equivalent (the "Aggregate Per Common Share
Price") shall be less than the applicable Conversion Price then in effect, or
if, after any such issuance of Common Stock Equivalents, the price per share for
which Additional Shares of Common Stock may be issuable thereafter is amended or
adjusted, and such price as so amended shall make the Aggregate Per Share Common
Price be less than the applicable Conversion Price in effect at the time of such
amendment or adjustment, then the applicable Conversion Price upon each such
issuance or amendment shall be adjusted as provided in the first sentence of
subsection (ii) of this Section 8.5 on the basis that (1) the maximum number of
Additional Shares of Common Stock issuable pursuant to all such Common Stock
Equivalents shall be deemed to have been issued (whether or not such Common
Stock Equivalents are actually then exercisable, convertible or exchangeable in
whole or in part) as of the earlier of (A) the date on which the Company shall
enter into a firm contract for the issuance of such Common Stock Equivalent, or
(B) the date of actual issuance of such Common Stock Equivalent. No adjustment
of the applicable Conversion Price shall be made under this subsection (iii)
upon the issuance of any Convertible Security which is issued pursuant to the
exercise of any warrants or other subscription or purchase rights therefor, if
any adjustment shall previously have been made to the exercise price of such
warrants then in effect upon the issuance of such warrants or other rights
pursuant to this subsection (iii). No adjustment shall be made to the Conversion
Price upon the issuance of Common Stock pursuant to the exercise, conversion or
exchange of any Convertible Security or Common Stock Equivalent where an
adjustment to the Conversion Price was made as a result of the issuance or
purchase of any Convertible Security or Common Stock Equivalent.

         (iv) In case any shares of Common Stock or any Common Stock Equivalents
shall be issued or sold:

<PAGE>

                  (1) in connection with any merger or consolidation in which
the Company is the surviving corporation (other than any consolidation or merger
in which the previously outstanding shares of Common Stock of the Company shall
be changed to or exchanged for the stock or other securities of another
corporation), the amount of consideration therefore shall be, deemed to be the
fair value, as determined reasonably and in good faith by the Board of Directors
of the Company, of such portion of the assets and business of the nonsurviving
corporation as such Board may determine to be attributable to such shares of
Common Stock, Convertible Securities, rights or warrants or options, as the case
may be; or

                  (2) in the event of any consolidation or merger of the Company
in which the Company is not the surviving corporation or in which the previously
outstanding shares of Common Stock of the Company shall be changed into or
exchanged for the stock or other securities of another corporation, or in the
event of any sale of all or substantially all of the assets of the Company for
stock or other securities of any corporation, the Company shall be deemed to
have issued a number of shares of its Common Stock for stock or securities or
other property of the other corporation computed on the basis of the actual
exchange ratio on which the transaction was predicated, and for a consideration
equal to the fair market value on the date of such transaction of all such stock
or securities or other property of the other corporation. If any such
calculation results in adjustment of the applicable Conversion Price, or the
number of shares of Common Stock issuable upon conversion of this Note, the
determination of the applicable Conversion Price or the number of shares of
Common Stock issuable upon conversion of this Note immediately prior to such
merger, consolidation or sale, shall be made after giving effect to such
adjustment of the number of shares of Common Stock issuable upon conversion of
this Note. In the event Common Stock is issued with other shares or securities
or other assets of the Company for consideration which covers both, the
consideration computed as provided in this Section 8.5(iv) shall be allocated
among such securities and assets as determined in good faith by the Board of
Directors of the Company.

         (v) If, at any time after any adjustment of the Conversion Price then
in effect shall have been made pursuant to Section 8.5(iii) as the result of any
issuance of Common Stock Equivalents, and (x) such Common Stock Equivalents, or
the right of conversion or exchange in such Common Stock Equivalents, shall
expire, and all or a portion of such or the right of conversion or exchange with
respect to all or a portion of such Common Stock Equivalents, as the case may
be, shall not have been exercised, or (y) the consideration per share for which
shares of Common Stock are issuable pursuant to such Common Stock Equivalents
shall be increased, then such previous adjustment shall be rescinded and
annulled and the Additional Shares of Common Stock which were deemed to have
been issued by virtue of the computation made in connection with the adjustment
so rescinded and annulled shall no longer be deemed to have been issued by
virtue of such computation. Upon the occurrence of an event set forth in this
Section 8.5(iv)(y) above, there shall be a recomputation made of the effect of
such Common Stock Equivalents on the basis of: (1) treating the number of
Additional Shares of Common Stock theretofore actually issued or issuable
pursuant to the previous exercise of Common Stock Equivalents or any such right
of conversion or exchange, as having been issued on the date or dates of any
such exercise and for the consideration actually received and receivable
therefor, and (2) treating any such Common Stock Equivalents which then remain
outstanding as having been granted or issued immediately after the time of such
increase of the consideration per share for which Additional Shares of Common
Stock are issuable under such Common Stock Equivalents; whereupon a new
adjustment of the Conversion Price then in effect shall be made, which new
adjustment shall supersede the previous adjustment so rescinded and annulled.

<PAGE>

         8.6 Maturity. At the election of the Lender at any time after the
Maturity Date, the outstanding principal balance of this Note and, unless paid
in cash by or on behalf of the Company, all accrued and unpaid interest thereon,
shall be automatically converted into fully paid and nonassessable shares of
Common Stock. The number of Conversion Shares shall be determined by dividing
the aggregate principal amount and accrued and unpaid interest by the Conversion
Price in effect at the time of such conversion.

      9. COVENANTS OF THE COMPANY. The Company will, until the earlier to occur
of the conversion or repayment in full of this Note, have authorized a
sufficient number of shares of each class or series of capital stock into which
this Note is convertible pursuant to Section 8 hereof and shall reserve for
issuance upon conversion hereof a sufficient number of shares thereof.

      10. REGISTRATION RIGHTS. If at any time, the Company proposes to register
any of its securities under the Securities Act (the "Act"), whether or not for
its own account (other than by a registration statement on Form S-8 or Form
S-4), it shall give written notice to Lender of its intent to file a
registration statement and include in such registration statement that number of
Conversion Shares held by Lender or that number of shares requested by Lender to
be included in such registration Statement upon conversion, subject to the
limitations set forth in this Section 10 ("Piggyback Registration Rights").

10.1 Underwritten Public Offerings. If The Company elects to register its
securities by or through an underwriter, the Lender may elect to sell its
Conversion Shares on the same terms and conditions as apply to other selling
shareholders or may elect not to have its Conversion Shares included in such
registration. The Company shall pay all expenses in connection with the
registration of Lender's Conversion Shares pursuant to the Piggyback
Registration Rights.

10.2 Priority in Piggyback Registration. The Company shall not be required to
include any Conversion Shares to the extent the managing underwriter reasonably
believes and advises Lender that inclusion of such shares would materially
adversely affect such offering; provided, however, that any such reduction or
elimination shall be pro rata among all other holders of Common Stock exercising
any registration rights in proportion to the respective number of shares of
Common Stock requested to be registered, if any.

11. SUCCESSORS AND ASSIGNS. Subject to the restrictions on transfer described in
Sections 13 and 14 below, the rights and obligations of the Company and the
Lender of this Note shall be binding upon and benefit the successors, assigns,
heirs, administrators and transferees of the parties.

12. WAIVER AND AMENDMENT. Any provision of this Note may be amended, waived or
modified upon the written consent of the Company and the Lender.

<PAGE>

13. TRANSFER OF THIS NOTE OR SECURITIES ISSUABLE ON CONVERSION HEREOF. This Note
may not be sold, assigned or transferred by the Lender, without the prior
written consent of the Company, which consent shall not unreasonably be
withheld. With respect to any offer, sale or other disposition of the securities
into which this Note may be converted, the Lender will give written notice to
the Company prior thereto, describing briefly the manner thereof, together with
a written opinion of the Lender's counsel, or other evidence if reasonably
satisfactory to the Company, to the effect that such offer, sale or other
distribution may be effected without registration or qualification (under any
federal or state law then in effect). Upon receiving such written notice and
reasonably satisfactory opinion, if so requested, or other evidence, the
Company, as promptly as practicable, shall notify the Lender that the Lender may
sell or otherwise dispose of such securities, all in accordance with the terms
of the notice delivered to the Company. If a determination has been made
pursuant to this Section 12 that the opinion of counsel for the Lender, or other
evidence, is not reasonably satisfactory to the Company, the Company shall so
notify the Lender promptly after such determination has been made. Each
certificate representing the securities thus transferred shall bear a legend as
to the applicable restrictions on transferability in order to ensure compliance
with the Securities Act, unless in the opinion of counsel for the Company such
legend is not required in order to ensure compliance with the Securities Act.
The Company may issue stop transfer instructions to its transfer agent in
connection with such restrictions. Subject to the foregoing, transfers of this
Note or the securities underlying this Note shall be registered upon
registration books maintained for such purpose by or on behalf of the Company.
Prior to presentation of this Note or such securities for registration of
transfer, the Company shall treat the registered Lender hereof as the owner and
holder of this Note for the purpose of receiving all payments of principal and
interest hereon and for all other purposes whatsoever, whether or not this Note
shall be overdue, and the Company shall not be affected by notice to the
contrary.

14. ASSIGNMENT BY THE COMPANY. Neither this Note nor any of the rights,
interests or obligations hereunder may be assigned, by operation of law or
otherwise, in whole or in part, by the Company without the prior written consent
of the Lender.

15. NOTICES. All notices, requests, demands, consents, instructions or other
communications required or permitted hereunder shall in writing and faxed,
mailed or delivered to each party at the respective addresses or facsimile
numbers of the parties. All such notices and communications shall be effective
(a) when sent by Federal Express or other overnight service of recognized
standing, on the business day following the deposit with such service; (b) when
mailed, by registered or certified mail, first class postage prepaid and
addressed as aforesaid through the United States Postal Service, upon receipt;
(c) when delivered by hand, upon delivery; and (d) when faxed, upon confirmation
of receipt.

16. USURY. In the event any interest is paid on this Note that is deemed to be
in excess of the then legal maximum rate, then that portion of the interest
payment representing an amount in excess of the then legal maximum rate shall be
deemed a payment of principal and applied against the principal of this Note.

<PAGE>

17. WAIVERS. The Company hereby waives notice of default, presentment or demand
for payment, protest or notice of nonpayment or dishonor and all other notices
or demands relative to this instrument.

18. GOVERNING LAW. This Note and all actions arising out of or in connection
with this Note shall be governed by and construed in accordance with the laws of
the Commonwealth of Pennsylvania, without regard to the conflicts of law
provisions of the Commonwealth of Pennsylvania, or of any other state.

      IN WITNESS WHEREOF, The Company has caused this Note to be issued as of
the date first written above.

                                        DELTA MUTUAL, INC.
                                        a Delaware corporation

                                        By: ________________________________
                                            Name: Peter F. Russo
                                            Title: President & CEOExhibit 4.4

                               DELTA MUTUAL, INC.

                          COMMON STOCK PURCHASE WARRANT
                           (Void after March 31, 2006)
DM-2004-W-00-0
This is to certify that, for value received and subject to the conditions herein
set forth, _________________, (the "Warrantholder") is entitled to purchase, at
a price per share of Ten Cents ($0.10) per share, _______________ (0,000) shares
of common stock, par value $0.0001 per share (the "Common Stock"), of Delta
Mutual, Inc., a Delaware corporation (the "Company"), subject to adjustment as
provided below (such shares purchasable upon exercise of this Warrant are herein
called the "Warrant Stock"). This Warrant, in all events, shall be wholly void
and of no effect after March 31, 2006. The amount per share specified above, as
adjusted from time to time pursuant to the provisions hereinafter set forth, is
herein called the "Purchase Price." This Warrant may be exercised anytime after
its issuance. In the event of an exercise of this Warrant, the Warrant holder
shall surrender this Warrant to the Company with payment of the Purchase Price
(the date of such surrender being herein referred to as the "Date of Exercise").

1. By acceptance of this Warrant, the Warrantholder agrees, for itself and all
subsequent holders, that prior to making any disposition of this Warrant or any
Warrant Stock, the Warrantholder shall give written notice to the Company
describing briefly the manner in which any such proposed disposition is to be
made; and no such disposition shall be made unless and until (i) the Company has
received an opinion of counsel satisfactory to it to the effect that no
registration under the Securities Act of 1933, as amended (the "Act"), is
required with respect to such disposition; or (ii) a registration statement with
respect to the Warrant or the Warrant Stock has been filed by the Company and
declared effective by the Securities and Exchange Commission (the "Commission").

2. (a) If outstanding shares of the Company's Common Stock shall be subdivided
into a greater number of shares thereof or a dividend in Common Stock shall be
paid in respect of Common Stock, the Purchase Price in effect immediately prior
to such subdivision or at the record date of such dividend shall simultaneously
with the effectiveness of such subdivision or immediately after the record date
of such dividend be proportionately reduced and conversely, if outstanding
shares of Common Stock shall be combined into a smaller number of shares
thereof, the Purchase Price in effect immediately prior to such combination
shall, simultaneously with the effectiveness of such combination, be
proportionately increased. When any adjustment is required to be made in the
Purchase Price, the number of shares of Common Stock purchasable upon the
exercise of this Warrant shall be changed to the number determined by dividing
(i) an amount equal to the number of shares issuable pursuant to the exercise of
this Warrant immediately prior to such adjustment multiplied by the Purchase
Price in effect immediately prior to such adjustment, by (ii) the Purchase Price
in effect immediately after such adjustment.

<PAGE>

         (b) If there shall occur any capital reorganization or reclassification
of the Company's Common Stock (other than a change in par value or a subdivision
or combination as provided for in subparagraph (a) above), or any consolidation
or merger of the Company with or into another corporation, or in the case of any
sale, transfer or other disposition to another person, corporation or other
entity of all or substantially all the property, assets, business and good will
of the Company as an entirety, then, as part of any such reorganization,
reclassification, consolidation, merger, sale, transfer or other disposition, as
the case may be, lawful provision shall be made so that the registered owner of
this Warrant shall have the right thereafter to receive upon the exercise hereof
the kind and amount of shares of stock or other securities or property which
said registered owner would have been entitled to receive if, immediately prior
to any such reorganization, reclassification, consolidation, merger, sale,
transfer or other disposition, as the case may be, said registered owner had
held the number of shares of Common Stock which were then purchasable upon the
exercise of this Warrant. In any such case, appropriate adjustment (as
determined by the Board of Directors of the Company) shall be made in the
application of the provisions set forth herein with respect to the rights and
interests thereafter of the registered owner of this Warrant such that the
provisions set forth herein (including provisions with respect to adjustment of
the Purchase Price) shall thereafter be applicable, as nearly as is reasonably
practicable, in relation to any shares of stock or other securities or property
thereafter deliverable upon the exercise of this Warrant.

         (c) In case the Company shall declare a dividend upon shares of Common
Stock payable otherwise than out of earnings or earned surplus and otherwise
than in shares of Common Stock or in stock or obligations directly or indirectly
convertible into or exchangeable for Common Stock, the Warrantholder shall, upon
exercise of this Warrant in whole or in part, be entitled to purchase, in
addition to the number of shares of Common Stock deliverable upon such exercise
against payment of the Purchase Price therefor, but without further
consideration, the cash, stock or other securities or property which the holder
of Warrant would have received as dividends (otherwise than out of such earnings
or earned surplus and otherwise than in shares of Common Stock or in such
convertible or exchangeable stock or obligations), if continuously since the
date set forth above such holder (i) had been the holder of record of the number
of shares of Common Stock deliverable upon such exercise and (ii) had retained
all dividends in stock or other securities (other than shares of Common Stock or
such convertible or exchangeable stock or obligations) paid or payable in
respect of said number of shares of Common Stock or in respect of any such stock
or other securities so paid or payable as such dividends. For purposes of this
subparagraph (c), a dividend payable otherwise than in cash shall be considered
to be payable out of earnings or earned surplus and shall be charged in an
amount equal to the fair value of such dividend as determined by the Board of
Directors of the Company.

<PAGE>

      (d) In case at any time:

      (i) the Company shall pay any cash or stock dividend upon its Common Stock
or make any distribution to the holders of its Common Stock; or

      (ii) the Company shall offer for subscription pro rata to the holders of
its Common Stock any additional shares of stock of any class or any other
rights; or

      (iii) the Company shall effect any capital reorganization or any
reclassification of or change in the outstanding capital stock of the Company
(other than a stock split, a change in par value, or a change resulting solely
from a subdivision or combination of outstanding shares of Common Stock), or any
consolidation or merger, or any sale, transfer or other disposition of all or
substantially all its property, assets, business and good will as an entirety,
or the liquidation, dissolution or winding up of the Company; or

      (iv) the Company shall declare a dividend upon shares of its Common Stock
payable otherwise than out of earnings or earned surplus or otherwise than in
shares of Common Stock or any stock or obligations directly or indirectly
convertible into or exchangeable for Common Stock; then, in any such case, the
Company shall cause at least fifteen (15) days' prior notice thereof to be
furnished to the Warrantholder at the address of such holder shown on the books
of the Company. Such notice shall also specify the date on which the books of
the Company shall close, or a record be taken, for such stock dividend,
distribution or subscription rights, or the date on which such reclassification,
reorganization, consolidation, merger, sale, transfer, disposition, liquidation,
dissolution, winding up, or dividend, as the case may be, shall take place, and
the date of participation therein by the holders of Common Stock if any such
date is to be fixed, and shall also set forth such facts with respect thereto as
shall be reasonably necessary to indicate the effect of such action on the
rights of the Warrantholder.

<PAGE>

         (e) When any adjustment is required to be made in the Purchase Price,
the Company shall promptly mail to the Warrantholder a certificate setting forth
the Purchase Price after such adjustment and setting forth a brief statement of
the facts requiring such adjustment. Such certificate shall also set forth the
kind and amount of stock or other securities or property into which this Warrant
shall be exercisable following the occurrence of any of the events specified in
subparagraphs (b) or (c) above.

         (f) The Company will, at the request of the Warrantholder, within 120
days after the end of each of its fiscal years, mail to the registered holder of
this Warrant at the address of such holder shown on the books of the Company a
certificate (if the Company has engaged independent public accountants, such
certificate shall be prepared by such independent public accountants) (i)
specifying the Purchase Price in effect as of the end of such fiscal year and
the number of shares of Common Stock, or the kind and amount of any securities
or property other than Common Stock purchasable by the holder of this Warrant
and (ii) setting forth in reasonable detail the facts requiring any adjustments
made during such fiscal year.

3. The Company agrees that (i) a number of shares of Common Stock and other
securities and property sufficient to provide for the exercise of this Warrant
upon the basis hereinbefore set forth shall at all times during the term of
Warrant be reserved for the exercise hereof, and (ii) during the term of this
Warrant, it will keep current in filing any forms and other materials required
to be filed with the Commission pursuant to the Act and the Securities Exchange
Act of 1934, as amended.

4. Exercise may be made of all or any part of this Warrant by surrendering it,
with the purchase form provided for herein duly executed by the registered owner
hereof or by the holder's duly authorized attorney, at the principal office of
the Company, or at such other office or agency as the Company may designate,
accompanied by payment in full, in lawful money of the United States, of the
Purchase Price payable in respect of the Warrant Stock as to which this Warrant
is being exercised, as provided in the first paragraph of this Warrant. If this
Warrant is exercised as to less than all of the Warrant Stock, the Company will,
upon such exercise, execute and deliver to the registered owner hereof a new
Warrant (dated the date hereof) to purchase the Warrant Stock as to which this
Warrant was not so exercised. Notwithstanding anything herein to the contrary,
each certificate for Warrant Stock issued hereunder shall bear a legend reading
substantially as follows (unless the Company receives an opinion of counsel
satisfactory to it that such a legend is not required in order to assure
compliance with the Act).

<PAGE>

                  The shares represented by this certificate have not been
                  registered under the Securities Act of 1933, as amended, or
                  the securities laws of any State. These shares may not be
                  sold, transferred, assigned or hypothecated unless there is an
                  effective registration statement under such act covering such
                  shares or the company receives an opinion of counsel for the
                  holder of these shares reasonably satisfactory to the company,
                  stating that such sale, transfer, assignment or hypothecation
                  is exempt from the registration and prospectus delivery
                  requirements of such act and from registration or
                  qualification requirements of applicable State securities
                  laws.

5. All shares of Common Stock or other securities delivered upon the exercise of
this Warrant shall be validly issued, fully paid and nonassessable and the
Company will pay all taxes, if any, in respect of the issuance thereof upon
exercise of this Warrant.

6. (a) Subject to the provisions of Paragraph 1 hereof, this Warrant and all
rights hereunder are transferable on the books of the Company, upon surrender of
this Warrant, with the form of assignment attached hereto duly executed by the
registered holder hereof or by his attorney duly authorized in writing, to the
Company at its principal office hereinabove referred to, and thereupon there
shall be issued in the name of the transferee or transferees, in exchange for
this Warrant, a new warrant or warrants or like tenor and date, representing in
the aggregate the right to subscribe for and purchase the number of shares which
may be subscribed for and purchased hereunder.

<PAGE>

         (b) If this Warrant shall be lost, stolen, mutilated or destroyed, the
Company, on such terms as to indemnify or otherwise as it may in its discretion
reasonably impose, shall issue a new warrant of like denomination, tenor and
date as this Warrant so lost, stolen, mutilated or destroyed. Any such new
warrant shall constitute an original contractual obligation of the Company,
whether or not the allegedly lost, stolen, mutilated or destroyed warrant shall
be at any time enforceable by anyone.

         (c) The Company may deem and treat the registered holder of this
Warrant as the absolute owner of this Warrant for all purposes and shall not be
affected by any notice to the contrary.

         (d) This Warrant, including all the rights and obligations granted to
the Warrantholder hereunder, shall be specifically enforceable against the
Company by the Warrantholder, in addition to and not by way of substitution for,
any other remedies available to the Warrantholder, at law or in equity.

7. The Warrantholder shall not, by virtue of ownership of this Warrant, be
entitled to any rights whatsoever of a shareholder of the Company, but shall,
upon written request to the Company, be entitled to receive quarterly or annual
reports, or any other reports to shareholders of the Company.

IN WITNESS WHEREOF, the Company has caused this Warrant to be executed as of
September 20, 2004, by its duly authorized officer.

                                DELTA MUTUAL, INC.

                                By:______________________________
                                   Peter F. Russo, President and CEO

<PAGE>

                              ELECTION TO PURCHASE

The undersigned hereby irrevocably elects to exercise the right to purchase
__________________ shares of Common Stock of Delta Mutual, Inc., the Company
represented by this Warrant, and requests that certificates for such shares
shall be issued in the name of

_________________________________________________________________Name

_________________________________________________________________Address

_________________________________________________________________
                   Social Security or other identifying number

and be delivered to
_________________________________________________________________Name

_________________________________________________________________Address

and if said number of shares of Common Stock shall not be all the shares
evidenced by this Warrant, that a new Warrant certificate for the balance of
such shares be registered in the name of, and delivered to, the undersigned at
the address stated below.

Dated:               ,  200_

Name of Warrantholder:__________________________________________

Address:________________________________________________________

----------------------------------------------------------------

Signature:______________________________________________________

                                   ASSIGNMENT

(To be executed by the registered holder
if he desires to transfer the Warrant)

FOR VALUE RECEIVED, ___________________________ hereby sells, assigns and
transfers unto ______________________ the right to purchase
______________________________ shares of Common Stock of Delta Mutual, Inc.
evidenced by the attached Warrant and does hereby irrevocably constitute and
appoint __________________________________________ attorney to transfer the said
Warrant on the books of the Company, with full power of substitution.

------------------------------
Signature

------------------------------
Name of Registered Holder
(Print)

In the presence of:

------------------------------

Address:

------------------------------

------------------------------

NOTICE: The signature to the foregoing Assignment must correspond to the name as
written upon the face of the attached Warrant in every particular, without
alteration or enlargement or any change whatsoever.

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