Identification Form

Association Française pour le Nommage Internet en Coopération
Registry for .fr (France) and .re (Reunion Island) Internet domain names
Identification Form
in the framework of Registration Contract N°:
(All fields are obligatory)
Identification of the company
Company 1
SIREN / SIRET
EU VAT number
(Obligatory for EU companies)
Address of headquarters
Postal code and Town
Country
Represented by 2
Surname
First name
Occupation
Telephone
Fax
E-mail address*
URL
http://
Administrative contact
Financial contact
Surname
First name
Address
(If different from headquarters)
Postal code and Town
Country
Telephone
Fax
E-mail adress*
Technical contact
NOC **
Surname
First name
Address
(If different from headquarters)
Postal code and Town
Country
Telephone
Fax
E-mail adress*
*
**
The addresses mentioned above must be valid as soon as the identification form is sent to AFNIC.
Address where all correspondence concerning the administrative operations may be sent.
1
To join a recent KBIS extract (or equivalent, for companies subject to foreign law) or, for associations, a copy of the announcement in the
Official Journal.
2
Person with the power to represent and act in the name of the company.
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AFNIC - Immeuble International - 78181 Saint Quentin en Yvelines Cedex - France
Tel.: +33 1 39 30 83 00 - Fax: +33 1 39 30 83 19 – www.afnic.fr
Association Française pour le Nommage Internet en Coopération
Registry for .fr (France) and .re (Reunion Island) Internet domain names
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
I chose the following payment method:
(Tick the relevant box)
Direct debit (date of payment of invoices):
A direct debit authorisation form 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)
Bank card (debit from the date of payment of invoices):
Visa
Eurocard
Mastercard
Name of cardholder: ......................................................................
Number:
Expiry date:
———— ———— ———— ————
— — / 20— —
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AFNIC - Immeuble International - 78181 Saint Quentin en Yvelines Cedex - France
Tel.: +33 1 39 30 83 00 - Fax: +33 1 39 30 83 19 – www.afnic.fr
Association Française pour le Nommage Internet en Coopération
Registry for .fr (France) and .re (Reunion Island) Internet domain names
Publication on the AFNIC’s website:
The AFNIC publishes free of charge a list of Registrars on its website according to the company’s wishes.
It also distributes the list of services offered by the latter to its clients.
I wish to be included on the public list of the AFNIC Registrars. I accept that all information furnished
hereunder shall be displayed on the AFNIC's public site.
•
Contact details: (Obligatory information. See art. 7.1 indentation 5 of the Contract)
Surname: ...............................................................................................
(If different from the Registrar identification)
Adress: .....................................................................................................
.................................................................................................................
Postal code and Town:.............................................................................
Tel:...........................................................................................................
Fax: ..........................................................................................................
E-mail adress: ..........................................................................................
Website: ...................................................................................................
•
Service providers : (Obligatory information)
National cover
Website creation
Domain name registration only (without associated service)
Hosting
Special offer (domain name + services)
Network operator
Services for individuals
Services for professionals
I do not wish to be included on the public list of the AFNIC Registrars.
© AFNIC 2008 – December 2008
I declare full knowledge of the provisions of the Registration Contract.
Drawn up at ........................................ On ............................ Signature ......................................
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AFNIC - Immeuble International - 78181 Saint Quentin en Yvelines Cedex - France
Tel.: +33 1 39 30 83 00 - Fax: +33 1 39 30 83 19 – www.afnic.fr