The application can be faxed or mailed. Requests for a URN block will be
honored within thirty (30) business days of receipt of the fee.
| TO BE COMPLETED BY REQUESTOR: |
|
Administrator's Name (if different from requestor) |
| ________________________________________ |
|
________________________________________ |
| Requestor Name |
|
Administrator Name |
| ________________________________________ |
|
________________________________________ |
| Organization Name |
|
Organization Name |
| ________________________________________ |
|
________________________________________ |
| Mailing Address |
|
Mailing Address |
| ________________________________________ |
|
________________________________________ |
| Mailing Address Line 2 |
|
Mailing Address Line 2 |
| ________________________________________ |
|
________________________________________ |
| Phone Number |
|
Phone Number |
| ________________________________________ |
|
________________________________________ |
| Fax Number |
|
Fax Number |
| ________________________________________ |
|
________________________________________ |
| E-mail Address |
|
E-mail Address |
| ________________________________________ |
|
________________________________________ |
| URL |
|
URL |
| ________________________________________ |
|
________________________________________ |
Requestor/company hereby agrees to indemnify and hold IEEE harmless from
claim arising out of Requestor's use of Assignments or misuse of any assigned
number.