IP Request Form

In order to request additional IPs, please ensure the below form is filled out properly. Enter all information to the right of the colon (:). DO NOT modify the format of this template in any way.

JUSTIFICATION SECTION

List all IP addresses issued to your organization. Separate multiple ranges by a comma.
Existing IP address ranges:
Enter the total amount of addresses assigned to your own customers.
Assigned IPs:
Provide internal IP address utilization information. List IPs used by your websites, databases, etc.
Internal Usage:
Enter the amount of unassigned or available IP address space.
Unassigned:
List the number of IP addresses that utilize each type of service listed below.

• Shared Web Hosting:
• Dedicated Servers:
• Resellers:
• Name Servers:
• Virtual Private Servers:
• Internet Relay Chat (IRC):
• Co-location:
• Other (please specify):

3 - 6 Month Projection

List the number of IPs that will be needed for each type of service for the next 3 to 6 months.

• 3-Month 6-Month
• Shared Web Hosting:
• Dedicated Servers:
• Resellers:
• Name Servers:
• Virtual Private Servers:
• Internet Relay Chat (IRC):
• Co-location:
• Other (please specify):

Provide any additional information you would like us to consider for this IP request.

IP REQUEST SECTION

Allocations are made based upon the 3-month projection (assignments are based on CIDR ranges).

• /29 = 5 usable IP addresses
• /28 = 13 usable IP addresses
• /27 = 29 usable IP addresses

Amount of IP Addresses Requested (in CIDR):
CIDR Ranges Requested:

Enter the email account with which you login to https://secure.media-hosts.com
Account Email:
Enter the primary IP address that this request is for (if available).
Primary IP Address:

Instructions for Submitting the Form

Please complete the form and submit via e-mail to support@media-hosts.com.
As subject please enter “IP REQUEST”
Please allow up to 24 hours for us to process this request.