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Pioneer Telephone Cooperative.

IP Address

Allocation Request

In order to properly maintain the IP addreses that have been allocated to us by ARIN, Pioneer is requesting more information reguarding your IP resource request. Please fill out the following information:

1. Select one of the following:

2 Addresses - Included with circuit

4 Addresses - Included with circuit - Complete section 2 below

8 Addresses - $100/month - Complete section 2 below

16 Addresses - $175/month - Complete section 2 below - Will require further review by Pioneer personnel

2. Public IP Usage Table - Please complete the following table and list the use for each IP request. NOTE: This section is required if requesting 4 or more public IP addresses


IP

Device

Brief Description

Please select the number of IP addresses you are requesting

3. Enter your contact information


First Name
Last Name
Company Name
Address
Phone
Email