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
URL
http://
Address of headquarters
Postal code and Town
Country
Represented by 2
Surname
First name
Occupation
Telephone
Fax
E-mail address*
Administrative contact
Financial contact
Technical contact
NOC **
Surname
First name
Address
(If different from headquarters)
Postal code and Town
Country
Telephone
Fax
E-mail adress*
Surname
First name
Address
(If different from headquarters)
*
**
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
© AFNIC 2011 - January 2011
Postal code and Town
Country
Telephone
Fax
E-mail adress*
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 boxes)
 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)
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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
© AFNIC 2011 - January 2011
 Credit card
As soon as you receive the e-mail containing your login and password, please connect yourself
to the Extranet, in order to proceed to the payment of the contract rate.
Your account will be activated as soon as the payment is perceived.
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)
Address: ...................................................................................................
.................................................................................................................
Postal code and Town:.............................................................................
Tel:...........................................................................................................
Fax: ..........................................................................................................
E-mail address: ........................................................................................
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.
 I declare full knowledge of the provisions of the Registration Contract.
© AFNIC 2011 - January 2011
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