TO CONTRIBUTE (PLEDGE CARD)
(2004-2005 Fiscal Year)
It is our intention to make a voluntary contribution to ICANN in the amount of US$____________. This amount is to provide financial support to ICANN for the fiscal year 1 July 2004 through 30 June 2005. It will be used in accordance with the Budget, posted at http://icann.org/financials/budget-fy04-05-06oct04.html and adopted by the ICANN Board of Directors on 23 July 2004.
We agree to pay this amount on or before: __________________________.
This contribution is being made by the ccTLD registry listed below:
Registry Name: ___________________________________________
Two Letter Country Code: ___________________________________
Mailing Address: __________________________________________
Telephone: __________________ Fax: _______________________
E:mail address: ____________________________________________
Signed: _______________________________ Date: ______________