IP Address Space Assignment Request Form
Requestor
Your name:
Organization
Name of organization:
How many employees does your organization have?
How many locations does your organization have?
Are these locations connected to the Internet?
Yes
No
What is the IP space being used for?
Mail-Server
Routers
Proxy-Server
other Servers
PCs / Workstations
other Devices
Description of Organization:
Please enter a short description of your company
Address:
D-
Contact
(admin-c)
Name:
Phone:
+49
Email:
Fax:
+49
Ripe-Handle:
-RIPE
I don't have a ripe handle.
New Network
Please specify the number of IP addresses you need
NOW
in 1year
in 2years
Old Network
(Returned Address Space)
If you return old IP addresses please specify them here
/ 30 (4)
/ 29 (8)
/ 28 (16)
/ 27 (32)
/ 26 (64)
/ 25 (128)
/ 24 (256)
Comment
