INTENTION TO PAY ICANN (Alternative Form)
(2000-2001 Fiscal Year)

It is our intention to pay ICANN the amount of US$____________ for ICANN’s 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 2000 through 30 June 2001. It will be used in accordance with the Budget, posted at http://www.icann.org/financials/budget-fy00-01-06jun00.htm and adopted by the ICANN Board of Directors on 6 June 2000.  

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:    ________________________________