INTENTION TO PAY ICANN (Alternative Form)
(2001-2002 Fiscal Year)

It is our intention to pay ICANN the amount of US$____________ for ICANNís role in providing global services to the Internet community.† This amount is our share of financial support required by ICANN for the fiscal year 1 July 2001 through 30 June 2002. It will be used in accordance with the Budget, posted at http://www.icann.org/financials/budget-fy01-02-04jun01.htm and adopted by the ICANN Board of Directors on 4 June 2001.†

We agree to pay this amount within _____ days of receipt of invoice from ICANN.

This payment will be made by the ccTLD registry listed below:

Registry Name: ___________________________________________

Two Letter Country Code:† ___________________________________

Name: __________________________________________________

Mailing Address: __________________________________________

_______________________________________________________

_______________________________________________________

Telephone: __________________†††††† Fax: _____________________

E:mail address:† ___________________________________________

Signed: _______________________________†††††† Date:† ___________________

Title:††† ________________________________