FORM: IP Allocation Request

IP Allocation form

Requestors Username:

ORG2 Code:

Campus, Building, Room:

Data Center:

Blue Plate Number:

DNS Name:

System Type:

Manufacturer and Model:

Network adaptor manufacturer and model:

MAC Address:

VLAN:

Fixed IP Required:

Yes

If you require further information or assistance, please contact the IT Help Desk on (08) 830 25000 or 1300 558 654.