Application Form

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

Download Form

Application Form for Membership in btIX – Bhutan Internet Exchange

Affix Legal stamp & signature