#   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 ISP 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): 

#   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.

2a. Service Provider Name: 
2b. Postal Address: 
2c. Service Provider ASN: 
2d. Connectivity Status:  

#   Information about the usage of the IP Block.
#   Inform all IP blocks previously assigned to the organization
#   either by LACNIC or by the organization's Internet providers.

#   Copy the following fields for each one of the Blocks you need
#   to represent on this request

3a. IP Block:    ex. 200.x.x.x/20
3b. Assigned:   ex. 10 prefixes /24
3c. Reserved:  ex. 4
3d. Available: ex. 2
3e. Services you provide with this Block(s): 

#   In the following fields, provide us information about the how
#   many client does your Organization work with, and  which service
#   you provide them

4a. Dial-up: 
4b. Cable: 
4c. Webhosting: 
4d. Leased Line: 
4e. xDSL: 
4f. Co-location: 
4g. Wireless: 
4h. Other (please specify): 

5a. Rang of CIDR you wish to request: 

#   Information about the usage for the next 12 months

5b. Dial-up:  ex. 10% or prefix /24 or total IPs 256
5c. Cable: 
5d. Webhosting: 
5e. Leased Line: 
5f. xDSL: 
5g. Co-location: 
5h. Wireless: 
5i. Other (please specify): 

#   In this point you can provide additional information about your
#   Organization, also if you wish, some additional information about 
#   any of the previous items.

6a. Additional Information: 

#   Do not remove this line.
End of template