Identification form - Afnic

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Annual fixed rate I chose the option of the following service: Tick the relevant box Option 1: Annual rate of 1,450 euro before tax or 1,734.20 euro (VAT inclusive at a rate of 19.6%) to be paid in full. Option 2: Annual rate of 500 euro before tax or 598.00 euro (VAT inclusive at a rate of 19.6%) to be paid in full. Method of payment This section is intended for new registrars or for registrars willing to modify their method of payment. I chose the following payment method: Tick the relevant boxes Direct debit (date of payment of invoices): A direct debit authorisation <strong>form</strong> duly completed and signed (See Appendix 2 of the Contract). Bank, postal or savings account details in the company name. Bank transfer to the AFNIC: Bank : CCM Noisy le Roi – Bank code: 10278 - ATM: 06106 Account: 00080487241 - Key: 32 IBAN (International Bank Account Number): FR76 1027 8061 0600 0804 8724 132 Code BIC (Bank Identifier Code): CMCIFR2A Beneficiary customer: AFNIC Immeuble International - 2, rue Stephenson Montigny-le-Bretonneux 78181 SAINT-QUENTIN-EN-YVELINES Cedex (France) Credit card Page 2/3 - Association Française pour le Nommage Internet en Coopération | www.afnic.fr | contact@afnic.fr Twitter : @AFNIC | Facebook : afnic.fr Tél. : +33 1 39 30 83 00 - Fax : +33 1 39 30 83 19 © AFNIC 2012 - Version Janvier 2012
Publication on the AFNIC’s website AFNIC provides a list of registrars on its website including a description of services they offer to their customers. Contact details: Mandatory in<strong>form</strong>ation Surname: ......................................................................................................... (If different from the Registrar identification) Address:................................................................................................. ............................................................................................................... Postal code and Town: .......................................................................... Tel: ......................................................................................................... Fax: ........................................................................................................ E-mail address: ...................................................................................... Website: ................................................................................................. Service providers Extensions proposées National cover .fr Website creation .re Domain name registration only .pm (without associated service) .yt Hosting .wf Special offer (domain name + .tf services) Network operator Services for individuals Services for professionals IPV6 DNSSEC Private offer I declare full knowledge of the provisions of the Registration Contract. Drawn up at ................................ On ......................... Signature ................................. © AFNIC 2012 - Version Janvier 2012 Page 3/3 - Association Française pour le Nommage Internet en Coopération | www.afnic.fr | contact@afnic.fr Twitter : @AFNIC | Facebook : afnic.fr Tél. : +33 1 39 30 83 00 - Fax : +33 1 39 30 83 19
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Identification form - Afnic

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