Please use the CIDR block representation of IP addresses, for example,
/29 for an 8-block of addresses.
4-block ( 1 usable IP + router) = /30
8-block ( 5 usable IPs + router) = /29
16-block ( 13 usable IPs + router) = /28
32-block ( 29 usable IPs + router) = /27
Size of Block:
For the purpose of the block, use the following keywords and separate
by commas if there are multiple uses within the block requested:
INTRANET SERVERS (internally-used servers, such as mail, etc.)
INTERNET SERVERS (mail servers, web servers, app servers, etc.)
WORKSTATIONS (client workstations)
WAN NETWORK (multiple-location connections)
LAN NETWORK (internal or "intranet" servers)
EMPLOYEE NETWORKS (such as telecommuters, etc.)
THIRD PARTY NETWORKS (organizations sharing your network resources)
Purpose of Block:
If you included "WAN NETWORK" are you providing access to additional
locations beyond your primary location?
If you currently have any blocks or previously had any blocks
from an ISP or ARIN, please list them here:
Blocks Were From
Name of Previous ISP
Please fill out the following table. For "Purpose," please use those
specified in earlier.
You agree that these are IP addresses that will be reachable by
"ping" or port (http, ftp, etc.) connections within the time
period specified in each column. Initially means within the
first month.
You also agree that if your range is under utilized as per this
application, we reserve the right to pull back addresses.
Purpose:
# of IPs Initially
# of IPs in 3 months
# of IPs in 1 year
Important Note:
All third-parties given blocks by your organization which are
larger than /29 (8-block of IPs) are required to fill out an
additional copy of this form for our records, or process their ranges
through the SWIP procedure or the implementation of an RWHOIS server.
Information is available in the RFC 2050 document available on
the http://www.arin.net site.
All customer ranges given to our customers are provided in a public
RWHOIS server as per RFC 2050. Currently, the information provided
to the public includes only: IP range/CIDR block, Organization Name,
Contact Name, and Contact EMail address (from sections 1a, 1c, and 1h,
found above).
Type of network:
Questionnaire
1. You agree to fill out this form every time there is a major
change to your network topography, contact information, or other
aspects that make the information on this form obsolete and send
it to
2. You agree to follow RFC 2050's guidelines as stated in the
"IMPORTANT NOTE" above
3. You provide this information in good faith and believe it to be
accurate
4. You grant Madison River Communications (and its ILEC/CLEC
operations) full right to move/change/modify IP address ranges,
including the ability to revoke IPs that are not used in your
time frame specified here
Thanks for taking the time to fill out this form.
By submitting this form, I agree to pay Coastal Communications the amount
listed below
/30 (1 IP) - $9.95/mo
/29 (5 IPs) - $39.95/mo
/28 (13 IPs) - $87.95/mo
/27 (29 IPs) - $174.95/mo
***Allocation of additional IP addresses may take 3 - 4 weeks to process.***
