
Appendix G: IP network number requests 173
Table 37 NIC IP address request form
IP address request form (continued)
1)If the network will be connected to the Internet, you must provide the name of the governmental sponsoring organization, and the name, title, mailing address, phone number, net mailbox, and NIC handle (if any) of the contact person (POC) at that organization who has authorized the network connection. This person will serve as the POC for administrative and policy questions about authorization to be a part of the Internet. Examples of such sponsoring organizations are: DISA DNSO, the National Science Foundation (NSF), or similar military or government sponsors.
NOTE: If the network will NOT be connected to the Internet, you do not need to provide this information.
1a. Sponsoring organization:
1b. Contact name (Last name, First name):
1c. Contact title:
1d. Mail address:
1e. Phone:
1f. Net mailbox:
1g. NIC handle (if known):
2)Provide the name, title, mailing address, phone number, and organization of the technical POC. The
2a. NIC handle (if known):
2b. Technical POC name (Last name, First name):
2c. Technical POC title:
2d. Mail address:
2e. Phone:
2f. Net mailbox: