SES WORLD SKIES IP Address Space Request Form

I. General Information

#[ OVERVIEW OF ORGANISATION TEMPLATE ]#
Please fill in a description of your company and what the addresses will be used for.
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#[ USER TEMPLATE ]#
Please fill in contact information about your organisation.
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Contact Name
User Organisation
User Address
User Country
User Telephone Number
Fax Number
Email Address

#[ CURRENT ADDRESS SPACE USAGE TEMPLATE ]#
Briefly describe all address segments that are currently in use including address space assigned by other providers. Do not include information here for address space you are requesting nor about private address space.
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Addresses Used
Prefix Subnet Mask Size Current One Year Two Year Description

II. The Request

#[ REQUEST OVERVIEW TEMPLATE ]#

Please answer the following questions about your request.
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What is the start of service date for your service with New Skies (in the format yyyymmdd)
In which country is the headquarters located ?
Why are you not using private addresses ?
Has your request been refused in the past ? YesNo
If yes, why, and how has the situation changed ?
Are you requesting Provider Independent addresses ? YesNo
Are you returning addresses ? YesNo
If yes, please fill in what range will be returned on what dates to what provider ?

#[ ADDRESSING PLAN TEMPLATE ]#

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Relative Prefix Subnet Mask Size Hosts Immediate Hosts Year One Hosts Year Two Description
0.0.0.0

III. Optional Information

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Any additional information may be entered here. It will not be checked by the robot.

Note that only syntax checks will be performed and nothing will be done with your request. To actually be given addresses, you must send the plain text version of your request by email to iprequest@newskies.com (or click the Send Request to New Skies button) and you must be a New Skies customer. Further automatic and human checks must also be passed.

Contact Name
User Organisation
User Address
User Country
User Telephone Number
Fax Number
Email Address

			Addresses Used
Prefix	Subnet Mask	Size	Current	One Year	Two Year	Description

What is the start of service date for your service with New Skies (in the format yyyymmdd)
In which country is the headquarters located ?
Why are you not using private addresses ?
Has your request been refused in the past ?	YesNo
If yes, why, and how has the situation changed ?
Are you requesting Provider Independent addresses ?	YesNo
Are you returning addresses ?	YesNo
If yes, please fill in what range will be returned on what dates to what provider ?

Relative Prefix	Subnet Mask	Size	Hosts Immediate	Hosts Year One	Hosts Year Two	Description
0.0.0.0