IP Address Request
(ARIN Justification Form)
Only required for /27 blocks (30 IPs) & above.
HOST.NET 3500 NW Boca Raton Blvd, Bldg 900 Boca Raton, FL 33431 Phone: (877) 556-iNOC Fax: (888) 882-4FAX Online: www.host.net
I. Company Information
Phone: Accnt #(If existing): Fax: Technical Contact: E-Mail Service Information: (check appropriate service(s) that apply) Company Name: Service: New Existing New IP Block On-Net
Addition to Existing Block Dedicated Internet Access
Replace Existing Block Co-location
In-Building Ethernet (IBE)
II. Current IPv4 Address Space Utilization
Please list your current IP Address space (if any), including space from Host.net and/or other ISPs. Network Size Assigned By Assign Date % in use
IP Addresses Guide:
CIDR Prefix: IP Addresses: /24 254
/25 126 /26 62
/27 30 /28 14
/29 6
/30 2
III. IPv4 Address Space Request
(Please allow 3-7 business days for processing of your request)
Please list your requested IP Address space below. Total Number of IP Addresses Immediate Usage Needed (use guide above)
3 Months Forecast
Route Destination Address
Reason for Use
Select use of IP's Select use of IP's Select use of IP's Select use of IP's
Describe your planned usage of the requested IPv4 address space. If you are providing webhosting services and are doing IP-based hosting, please provide a list of technical reasons why named-based hosting cannot be done.
How would you like your space advertised? Do you intend to use Host.nets DNS servers?
Statically Routed Customer No No No No Yes
Customer Advertised BGP
Yes ns1.host.net= 64.135.1.22, ns2.host.net= 64.135.2.250 Yes Nameserver(s): Yes
Do you wish us to provide default reverse DNS? Do you wish reverse DNS to be delegated? Do you intend to run your own mail server?
IV. Additional Comments
Host.net IP Address Request V5.0 01/03/08
IP Address Request
(ARIN Justification Form)
Only required for /27 blocks (30 IPs) & above.
HOST.NET 3500 NW Boca Raton Blvd, Bldg 900 Boca Raton, FL 33431 Phone: (877) 556-iNOC Fax: (888) 882-4FAX Online: www.host.net
V. Optional Information
How would you like your space advertised? Do you intend to use Host.nets DNS servers? Do you wish us to provide default reverse DNS? Do you wish reverse DNS to be delegated? Do you intend to run your own mail server? Statically Routed Customer No No No No Yes Yes Nameserver(s): Yes Customer Advertised BGP Yes ns1.host.net= 64.135.1.22, ns2.host.net= 64.135.2.250
Please return the completed form to your Host.net Account Executive or the Network Operations Center. Failure to provide the requested details may cause a delay in provisioning your IP Address Space Request.
Requested Authorization:
By signing this document I agree to be bound by ARINs IP assignment policy as administered by Host.net. I am requesting the smallest possible amount of address space possible necessary for my present and future needs. I understand that should I not reach the utilization thresholds prescribed by these policies, I may have my address space reassigned to a smaller block. I also have read and agree to be bound by Host.nets AUP and network management policies. Printed Name: Signature:
Title: Date:
Host.net IP Address Request V5.0 01/03/08
