btIX Logo Application Form for Membership in btIX – Bhutan Internet Exchange


1. Name and Address of Applicant
*Address must be equal with the registered address in the License issued by BICMA/Department of Trade.
2. Technical Contact Persons
3. Technical Details
4. Billing Address
5. Application and Declaration for btIX Participation

FOR OFFICIAL USE ONLY!
Created by : Peering IPv4 Address :
Membership ID : Peering IPv6 Address :
IX Switch Port # : Configured by :
Activation # :
Affix Legal stamp & signature