Application Form

Name of Organisation (*)
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Postal Address (*)
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Telephone
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Fax
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Registered Address (*)
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Company Reg No (*)
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Business Contact
Name
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Telephone
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Fax
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Email (*)
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Technical Contact
Name
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Telephone
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Fax
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Billing Details
Billing Name (if different from above)
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Billing Address (if different from above)
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VAT Number
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Billing Contact
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Telephone
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Fax
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Email
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Emergency NOC Information
Telephone
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Fax
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Information for Edge-IX Website
Website URL
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Sales Email
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Peering Email
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Transit Email (if applicable)
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Peering Policy (optional information)
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Connection Information
Please indicate your timescale for connection:
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Sites you Intend to connect at





























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Speed(s)/Presentation(s) you intend to connect at




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AS Number(s) to be announced at Edge-IX
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Fully qualified domian name for applicants router at Edge-IX to be referenced in the Edge-IX in-addr.arpa.zone
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RIPE Registry ID
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Promotion Code
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Email address of the person completing this form or the person we should contact regarding this application
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Telephone number of the person completing this form or the person we should contact regarding this application
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Please indicate what letters you see in the box Please indicate what letters you see in the box
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Silk Point, Queens Avenue

Macclesfield, Cheshire

SK10 2BB

Tel: 0161 200 1610

Fax: 0161 200 1619

Email: info@nwix.com