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[NOC: Common Customer Requests]

IP Address Request Form

Please fill out the following form as completely as possible. A CENIC NOC representative will contact you within 24 hours of your request.

Please familiarize yourself with our IP Allocation Policy prior to making your request.


About Your Existing Network:

Your Name:

Your E-mail Address:

    About Your Existing Network:

  1. List your current Internet Service Provider(s):

  2. List the current IP blocks you have already been assigned from all providers:

  3. How many /24 networks are being requested? Each /24 contains 256 addresses:

  4. Existing Network Topology:
    Explain how the address space in item 2 are currently being utilized, using the format below:

  5. Explain how the current and requested address space combined will be utilized, both intially (within a month after receiving the additional space) and after one year, using the format below:

  6. Provide additional information for CENIC to consider for this network request. This could include any explanations if unable to satisfy CENIC policy. If you are planning to migrate away from and return old IP address space, please provide information here regarding plans for that migration:


  7. Registration Information:

  8. ARIN Organization ID, if any:

  9. If you have DNS servers to which you would like us to delegate the reverse domains for these new networks, please list their hostnames here:


  10. Technical Contact Information:

  11. Tech POC Name:

  12. Tech POC Title:

  13. Tech POC Phone:

  14. Tech POC E-mail:


  15. Abuse Contact Information:

  16. Abuse POC Name:

  17. Abuse POC Title:

  18. Abuse POC Phone:

  19. Abuse POC E-mail:


  20. Administrative Contact Information:

  21. Admin POC Name:

  22. Admin POC Title:

  23. Admin POC Phone:

  24. AdminPOC E-mail:








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