#   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 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): 

#   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: 

#   Inform all IP blocks previously assigned to the organization
#   either by LACNIC or by the organization's Internet providers.

3a. Previously assigned IP Addresses: 

#   Infrastructure.
#   Using the format below, provide information
#   about the use of IP Address space currently assigned
#   to your organization and used for internal equipment.

3b. Use of existing IP Addresses:
----------------------------------------------------------------------
IP Addresses     Number of Hosts          Purpose
----------------------------------------------------------------------
x.x.x.x          xx

----------------------------------------------------------------------

4a. Number of requested IP Addresses:


#   Provide detailed information showing how the IP Addresses are
#   going to be used in periods of 6 and 12 months like in the example

#   The subneting plan is also required, this plan must represent at
#   least the first year, include in the format below the Subnet Mask,
#   the Numbers of Hosts of each subnet and its purpose.

4b. Utilization of the requested IP Addresses:
-----------------------------------------------------------------------
Subnet Mask Numbers of Hosts today, 6Months, 12Months Purpose
-----------------------------------------------------------------------
255.x.x.x            xx              xx       xx        

-----------------------------------------------------------------------
    Totals          xx              xx       xx
-----------------------------------------------------------------------

#   Provide a detailed description of the routing plans of the network
#   including the protocol of routing that will be used and any existing
#   limitation

4c. Routing Protocol:
4d. Routing Plan:

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

5a. Additional Information:

#   Do not remove this line
End of template