Identification form - Afnic

All fields are mandatory
Identification Form
in the framework of Registration Contract n°:
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*
Surname
First name
Address
(If different from headquarters)
Postal code and Town
Country
Telephone
Fax
E-mail address*
Surname
First name
Address
(If different from headquarters)
Postal code and Town
Country
Telephone
Fax
E-mail address*
Administrative contact
Financial contact
Technical contact NOC **
* 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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- 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

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 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)
Credit card
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- 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 information
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
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- 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