INTENTION TO PAY ICANN (Alternative Form)

It is our intention to pay ICANN the amount of $____________ 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 July 1, 2000 through June 30, 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 with _____ 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:    _______________________________