Request an IP Address

Fill out the form below to request an IP Address.

Full Name:
E-Mail:
Phone Number:
Enter the Officer/Workspace Number:
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Location should be in the form of either "2139" for an office number or 2.A.19 for an "open workspace".
Jack Number:
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Please enter the entire text that is on the label on the jack that you intend to plug this host into, in the form: "TC - 2nd Floor East 23A".
Division:
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Please enter the division you are working for, in the form of "MCS" or "ALCF" or "CLS", etc.
Hostname:
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Please enter your desired hostname for this request.
Hardware MAC Address (Wired ONLY):
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Please enter a valid wired MAC Address.
Interface type for MAC Address
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Select the type of interface the above MAC address applies to.
Operating System:
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Please choose the Operating System you are using.
CSI Number:
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If this device has a CSI number, please provide it.
Old CSI Number:
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If this is replacing an old host, please provide the CSI number of the old device.
Needed Until:
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If you know when this machine is no longer needed, give us a date that we can deactivate it.
Comments:
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