Please complete this form making sure all details are accurate.
Once submitted, a copy of this document will be sent to your email address and another copy will be sent to the Datanet technical team.
Customer Details
Company Name
Address *
Town
County
Postcode
Contact Name
Contact Telephone Number *
Contact Email *
Requested Due Date (dd-mm-yy) *
Technical Network Contact (24 hours). Details to be provided if you do not wish to use Datanet as contact.
Contact Name*
IP Address Details
Total number of IP addresses you are requesting:
Please fill in your IP requirements for 1st year, 2nd year and 3rd year.
Number of Devices
Year 1
Year 2
Year 3
Servers
Network Hardware
Other
Total ISP's
Do you have servers that require multiple IPs? YesNo
If yes please explain:
Networking Services
Will you be using Network Address Translation (NAT) on your Internet firewall or router? YesNo
Do you use any applications that make it infeasible to use NAT on your network? YesNo
If yes, please describe any unique applications or requirements that may impact your IP address request:
Please give a brief description of what type of network traffic you plan on transporting with these IP addresses. Include the types of applications being used. (e.g. MS Exchnage, Citrix, Video Conferencing, Web Server, Network Backup etc.)
Please describe your network topology: