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IP Address Request Form

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  • 7 May 2019 8:41 AM

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.


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