ICANN will soon be accepting applications for new TLDs. As a leading registry services provider, Afilias is interested in learning more about YOUR new TLD to help us determine how we can best work together. Please provide the information requested below and Afilias staff will review your new TLD idea. The information that you provide us will be kept strictly confidential.

First Name: *

Last Name: *

Title: *

Company: *

Street Address:

Street Address:

City: *

State/Province:

Zip/Postal Code:

Country:

Phone where you may be reached: *

Email: *

Which of the below best describes your prospective TLD(s)? Check as many as apply.:

Open TLD (open for anyone to register)

Corporate brand or identity (for internal use only)

Corporate brand or identity (open to public registration)

Community TLD (per ICANN definition)

Other

What type of services are you seeking from Afilias? Check as many as apply.:

Back-end Technical Provider

Complete Registry Solution

Application Services

Consulting

Other

Additional comments or questions:

How did you hear about Afilias?: * select... Web Search Word of Mouth Partner/Reseller Referral Conference/Tradeshow Media/Blog Post/News Site Online Video Social Media Direct Mail/Email Other

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