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#[GENERAL INFORMATION]#
request-type: pa-ipv4
form-version: 1.0
x-ncc-regid: 

#[ADDRESS SPACE USER]#
%
% Who will use the address space being requested?
organisation-name: 
organisation-location: 
website-if-available: 

%
% Does the organisation already have address space that 
% can meet the needs for this request? Enter "Yes" or "No".
space-available: 

#[ADDRESSING PLAN]#
number-of-subnets: 
address-space-returned: 

%
%        Size 
%        in CIDR    Immediate   1yr   2yr   Purpose
subnet:
totals:

%
% Which netname will be used when registering this network in 
% the RIPE Database?
netname: 

#[EQUIPMENT DESCRIPTION]#
%
% Please describe the equipment that will be used in the 
% network. Indicate the function of the equipment and provide 
% information regarding the way it uses IP address space.
equipment-name:
manufacturer-name:
model-number:
other-data:

#[NETWORK DESCRIPTION]#
%
% If your description does not allow the Hostmaster to 
% understand the request you may be asked additional 
% questions. Please add any additional information that you 
% think may facilitate the evaluation of this request below.

#[NETWORK DIAGRAM]#
%
% Please enter "Yes" or "No" if you have attached a network 
% diagram in JPEG or PostScript format to this e-mail 
% request. 
diagram-attached:

#[END of REQUEST]#

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