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Internet Corporation for Assigned Names and Numbers
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New sTLD Application
Part B. Application Form
15 December 2003
Part A. Explanatory Notes | Part B. Application Form | Part C. Business Plan | Part D. Financial Model | Part E. Technical Specification | Part F. Application Checklist
| Company Name | ___________________________________________ |
| Company Address 1 | ___________________________________________ |
| Company Address 2 | ___________________________________________ |
| Company City | ___________________________________________ |
| Company State/Province | ___________________________________________ |
| Company Postal Code | ___________________________________________ |
| Company Website Address | http://_______________________________________ |
| Company Country | ___________________________________________ |
| Company Contact Name | ___________________________________________ |
| Company Contact Email | ___________________________________________ |
| Company Contact Phone | ___________________________________________ |
| Company Contact Mobile | ___________________________________________ |
| Company Contact Fax | ___________________________________________ |
| Company Alternate Contact Name | ___________________________________________ |
| Company Alternate Contact Email | ___________________________________________ |
| Company Alternate Contact Phone | ___________________________________________ |
| Company Alternate Contact Mobile | ___________________________________________ |
| Company Alternate Contact Fax | ___________________________________________ |
| Sponsoring Organization Name | ___________________________________________ |
| Sponsoring Organization Address 1 | ___________________________________________ |
| Sponsoring Organization Address 2 | ___________________________________________ |
| Sponsoring Organization City | ___________________________________________ |
| Sponsoring Organization State/Province | ___________________________________________ |
| Sponsoring Organization Postal Code | ___________________________________________ |
| Sponsoring Organization Country | ___________________________________________ |
| Sponsoring Organization Website Address | http://_______________________________________ |
| Sponsoring Organization Contact Name | ___________________________________________ |
| Sponsoring Organization Contact Email | ___________________________________________ |
| Sponsoring Organization Contact Phone | ___________________________________________ |
| Sponsoring Organization Contact Mobile | ___________________________________________ |
| Sponsoring Organization Contact Fax | ___________________________________________ |
| Wire Transfer Receipt Number | ___________________________________________ |