#   ATENTION: Read carefully the comments about every field of the
#   request, if you have any doubt, comments or suggestions do not
#   hesitate about getting in touch with as at hostmaster@lacnic.net

#   Filling incorrectly the fields may mean the automatic
#   reject of the request

#   Do not remove this line
LACNIC IPV6 END-USER Template 20080827-EN

#   Send this request to hostmaster@lacnic.net

#   Information about Organization
#   if your organization already holds any resources registered with
#   LACNIC, please provide the "Owner ID" and the name of the
#   organization as it is registered in our system. In case you don't
#   know the "Owner ID", please check a resource allocated to your
#   organization at LACNIC's WHOIS server:
#   http://whois.lacnic.net

0a. ID. of Organization (OwnerID): 
0b. Name of the Organization: 
0c. Postal Address: 
0d. City: 
0e. State: 
0f. Country: 
0g. ZIP Code:

#   Points of contact in the Organization
#   it is necessary to inform at least a technical, billing
#   and a membership contact. Billing and membership contacts
#   are for internal use only, therefore not visible at the WHOIS.
#   Inform only the UserID for each contact. In case you don't have one
#   you must create it at:
#   http://lacnic.net/newid/EN

1a. Technical Contact (UserID): 
1b. Billing Contact (UserID): 
1c. Membership Contact (UserID):  

#   Provide Information about the Organization requesting IPv6 Block

2a. Information about the Organization: 

#   Internet Connection.
#   Specify service provider(s) name, postal address, ASN
#   and status of provider's connection. If you have more than
#   one provider, copy the items below as many times as necessary.

3a. Service Provider Name: 
3b. Postal Address: 
3c. Service Provider ASN: 
3d. Connectivity Status: 

#   Inform when will IPv6 network be set up and the plan of usage
#   of the IPv6 addresses 

4a. Date:
4b. Plan of usage of the IPv6 addresses:

#   Inform the size of the Block you wish to request. LACNIC will
#   normally assign /48, but bigger assignations may be justify
#   if they are bigger up to /32 delivering documentation justifying it. 

5a. IPv6 Block you wish to request: 

#   Provide information about the structure of the IPv6 network
#   specially a detailed diagram of the net and the addressing and
#   routing plans.
#   In case you are requesting a larger block than /48, also
#   provide information justifying your need.

6a. Additional Information:

#   Do not remove this line.
End of template