IPv4 request

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Who will use the requested address space*?

<legal name of organisation>
<website (if available)>

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Briefly describe the purpose for which the addresses will be used*:

<your description>

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Please write out your addressing plan as detailed as possible*:

<subnet1 size> <purpose>
<subnet2 size> <purpose>
<total subnet size>

<total number of subnets>

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Would you prefer continuous address space (if this request is for multiple /24:s)?

<yes/no>

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Contact details (this information will be published in the RIPE db):

Specify contact details for the administrative contact person(s)*:

<name>
<postaladress and city>
<e-mail adress>
<phone number>

<name>
<postaladress and city>
<e-mail adress>
<phone number>

Specify contact details for the technical contact person(s)*:

<name>
<postaladress and city>
<e-mail adress>
<phone number>

<name>
<postaladress and city>
<e-mail adress>
<phone number>

Please specify an e-mail address for handeling of abuse reports*:

<abusemailbox>

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Any requests for the inetnum object may be added below (will be published in the RIPE db):

inetnum:       <leave empty>
netname:       <add netname>
descr:         <add End User organisation name>
org:	       <add organisation object>
country:       <add country code>
admin-c:       <add nic-handle of administrative contact>
tech-c:        <add nic-handle of technical contact>
mnt-by:        RESILANS-MNT
mnt-routes:    <add mntner name>
source:        RIPE

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Please specify what name servers you wish to use for reverse DNS:

<name server>
<name server>
<name server>
<name server>

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Fields marked with * are mandatory.