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EIA IP Request Form for Non Standard CIDR /27, /26, /25 and /24

*Required Field

Submitted by:


List additional customer contact emails to carbon copy on the form submission confirmation.

Customer Information (End User Address)

Is this an existing circuit in service?

Customer Point-of-Contact Information (Carrier Customer)

Renumbering Information

Are you renumbering?

Are you returning your old?

Previous provider IP's must be returned after renumbering.

Name Server Information for Reverse DNS

If you are providing Name Server (NS) info then both a primary and secondary NS must be present.

Requested Netblock

IP Address Type*

Are you IPv6 Capable?

IPv4 CIDR Block Requested*

IPv6 CIDR Block Requested*

Current IP Address Usage

Provide the numbers detailing your current network to justify the requested IP Block.

Fields are required. Zero may be entered as a valid entry, however, total of all IP Address Usage fields must justify requested block size.

Will NAT be utilized?

Provide a list of address space already in use and whether you will be renumbering out of that address space or not. If you are a Wireless provider include network IP plan down to the Private space pools. Pinpoint the Public to Private ratio.

Explanation of Network Architecture

Provide detail explanation of your network architecture and how you will be using it.

Provide any additional details and provide quantity that will use a global/public IP address that was not yet accounted for above.

ALERT: A network diagram will be required if requesting a CIDR /26, /25 or /24. Please see direction provided on confirmation email received after form submission.