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Identification form - Afnic

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Annual fixed rate<br />

I chose the option of the following service:<br />

Tick the relevant box<br />

Option 1:<br />

Annual rate of 1,450 euro before tax or 1,734.20 euro (VAT inclusive at a<br />

rate of 19.6%) to be paid in full.<br />

Option 2:<br />

Annual rate of 500 euro before tax or 598.00 euro (VAT inclusive at a rate<br />

of 19.6%) to be paid in full.<br />

Method of payment<br />

This section is intended for new registrars or for registrars willing to modify their method of<br />

payment.<br />

I chose the following payment method:<br />

Tick the relevant boxes<br />

Direct debit (date of payment of invoices):<br />

A direct debit authorisation <strong>form</strong> duly completed and signed (See Appendix 2 of the<br />

Contract).<br />

Bank, postal or savings account details in the company name.<br />

Bank transfer to the AFNIC:<br />

Bank : CCM Noisy le Roi – Bank code: 10278 - ATM: 06106<br />

Account: 00080487241 - Key: 32<br />

IBAN (International Bank Account Number): FR76 1027 8061 0600 0804 8724 132<br />

Code BIC (Bank Identifier Code):<br />

CMCIFR2A<br />

Beneficiary customer: AFNIC<br />

Immeuble International - 2, rue Stephenson<br />

Montigny-le-Bretonneux<br />

78181 SAINT-QUENTIN-EN-YVELINES Cedex (France)<br />

Credit card<br />

Page 2/3<br />

- Association Française pour le Nommage Internet en Coopération | www.afnic.fr | contact@afnic.fr<br />

Twitter : @AFNIC | Facebook : afnic.fr<br />

Tél. : +33 1 39 30 83 00 - Fax : +33 1 39 30 83 19<br />

© AFNIC 2012 - Version Janvier 2012

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