Part 1
Requestor Name | first and last name of the individual that is requesting the assignment |
Job Title | name of the position held within the company |
Organization Name | name of the company |
Address Line 1 | first line of address |
Address Line 2 | second line of address (if applicable) |
City | city that company is located in |
State/Province | state or providence (whichever applies) that company is located in |
Zip or postal code | zip code or postal code that company is located in |
Country | country from drop down list that your company is located in |
Phone Number | phone number of Requestor |
Fax Number | fax number of Requestor |
E-mail Address | e-mail address of Requestor |
Part 2
Administrator Name | first and last name of the individual that is responsible for maintaining the assignment (can be same as Requestor) |
Job Title | name of the position held within the company |
Organization Name | name of the company |
Address Line 1 | first line of address |
Address Line 2 | second line of address (if applicable) |
City | city that company is located in |
State/Province | state or providence (whichever applies) that company is located in |
Zip or postal code | zip code or postal code that company is located in |
Country | country from drop down list that your company is located in |
Phone Number | phone number of Administrator |
Fax Number | fax number of Administrator |
E-mail Address | e-mail address of Administrator |
Part 3
Proforma Invoice | This option is chosen if an invoice is needed prior to releasing payment. If this option is not chosen prior to clicking submit, it will be necessary to complete another application in order to request an electronic version. |
Check | When the company is ready to send a check, it is imperative that it is sent to the exact address in the e-mail. |
Wire Transfer | The application will not be processed until the wire transfer confirmation of receipt from the IEEE Accounting department is received. The wire transfer receipt must be faxed if the payment is sent under a name other than the one on the application. |
Purchase Order | The purchase order must be faxed as stated in the e-mail that will be sent upon submittal of the application. |
Credit Card | Please ensure that the credit card number and expiration date are correct to avoid any delays in the processing of the request. |
Part 4
Box A | These are the details that will be reviewed in the application approval process. |
Box B | These are the details that will be posted to the public listing once it is revised. |
* The public reflector can be used to voice any concerns or spark discussions regarding any Registration Authority EtherType issues.