Application Form for Membership in btIX – Bhutan Internet Exchange 1. Name and Address of Applicant Company Name : Address : City : ZIP Code : Country : Phone # : Fax # : Website : *Address must be equal with the registered address in the License issued by BICMA/Department of Trade. 2. Technical Contact Persons Name of Technical Coordinator : Phone # : Fax # : Email Address : 3. Technical Details APNIC Member If member of other RIRs, please specify : AS Number : Port MAC Address : Customer IPv4 Address : Customer IPv6 Address : Port Speed : 1G 10G Do you want to peer with the Route Server? Yes No 4. Billing Address Contact Person : Phone # : Fax # : Email Address : Company Name : Address : City : ZIP Code : Country : 5. Application and Declaration for btIX Participation We hereby apply to participate in btIX in accordance with btIX Membership Terms & Conditions. We hereby declare that we have read and understood the btIX Membership Terms & Conditions. Finally, we give authorization to publish our business name on the list of trading participants on the btIX website. Place & Date Name & valid signature of Applicant FOR OFFICIAL USE ONLY! Created by : Peering IPv4 Address : Membership ID : Peering IPv6 Address : IX Switch Port # : Configured by : Activation # : Affix Legal stamp & signature
Application Form for Membership in btIX – Bhutan Internet Exchange