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1) Domain and Server Name:
Note: If more than one domain, use first domain registered.
A)
Do you have your own name server for hosting reverse DNS?
Yes
No
B)
If yes, what is/are the name(s) of the name server(s)?
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2) Do you have previously assigned addresses?
Yes
No
A)
If yes, what addresses were assigned?
Enter
Upload
Upload control will appear on the next step
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3) Are you renumbering into OMEGABYTE IP's?
Yes
No
A)
If yes, what is your timeframe for renumbering?
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4) Number of IP addresses required:
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5) Number of subnets required:
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Note: If your organization already has IP space assigned, you must utilize 80% before applying for more IP space.
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7) Please select all that apply and the number of machines using these various technologies:
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8) Please use the space provided to describe why you require the number of IP addresses requested in item
9. Please note that equipment behind firewalls does not require globally unique IP addresses. Please also
indicate whether you are conserving address space using address translation.
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9) Please complete a network table like the one you see below to show you have used any existing IP
assignments, and show predicted future growth of your network.
SAMPLE
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Network/CIDR
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Subnet Mask
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Max
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Now
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3 mo
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6 mo
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Description
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192.168.1.0/27
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255.255.255.224
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30
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8
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12
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16
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Network Infrastructure
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192.168.2.0/27
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255.255.255.224
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30
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17
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17
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22
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Engineering
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192.168.1.32/27
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255.255.255.224
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30
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12
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12
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12
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Manufacturing
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192.168.1.128/25
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255.255.255.128
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126
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40
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80
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110
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Management
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192.168.1.192/27
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255.255.255.224
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30
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10
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12
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20
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Sales
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192.168.1.224/27
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255.255.255.224
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30
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7
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20
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28
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Finance
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192.168.1.64/26
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255.255.255.64
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190
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100
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160
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180
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Servers/Web Sites
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Use the following Network Table as an template to describe your IP assignments today, in three months,
and in six months. Expand the table as necessary to accomodate your requirements. Please be as
accurate as possible when making projections.
Enter
Upload
Upload control will appear on the next step
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10) If your justification request is approved, we are obligated to submit SWIP your organizational information
(https://www.arin.net/resources/request/reassignments.html) to the ARIN WHOIS database.
A) Please list the ARIN ORG-ID you would like us to use for this assignment?
B). Will this be a reallocation or reassignment to the ORG-ID listed above?
Reallocation
Reassignment
* Note: If you do not have an ARIN ORG-ID, please contact ARIN.NET for information on how to set up a web account to request resources.
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AUTHORIZATION
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I verify that i am authorized to represent the organization below and that the above information is true and
correct. I understand that Internet Protocol Version 4 address space is limited and that users of the Internet
are responsible for conserving address space and ensuring that space is utilized efficiently.
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