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Connection Form (Confrm)

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NIXI CONNECTION FORM FOR MEMBER

ISP Non-ISP / CDN / CONTENT PROVIDER

Kindly complete this connection form to enable us to provide you connection.


This information allows the NIXI to perform the necessary admin,
configuration and wiring work to allow you to connect.

Name of NIXI location:


Port capacity______________________ Plan type__________________________
Member Contact Information:
Installation Site Please provide details.
Company Name Main Contact Phone
Site Address Fax

Mobile Email
To whom questions regarding the service
should be addressed
Pincode Position
Technical Contact on Site Fax Email
Contact Name Phone Provide here details of contact whom
Mobile
Out of Hours Reporting

NIXI can
contact in the event of service problems
outside of working hours.
24 hour contact numbers
Contact Names

Do you need consolidate bill for all locations?(If connected at multiple locations)

Billing Contact
Billing Contact Address
Provide details to whom invoices will be sent
Position Phone
Fax Mobile

Email

Member Signature
Company Seal
NIXI Service Details:

1. Access Circuit

Size of Circuit e.g.10 Gbps Circuit Provider


Expected date by which circuit provisioned
If you are providing your own circuit, please specify delivery date:

2. Router Details/Cache Server/Other Equipment Details


Dedicated Router Details (Owned, supplies and co-located at NIXI)

Height in U Height in Inches Heightin mm

Make and Model:

3. IP Addressing (NIXI will provide one IP address )


What are the assigned address ranges?
From where were these obtained?
Is your current IP address space? Provider Provider
Dependent Independent (Portable)

Current peering Connectivity

Member’s pre-NIXI peering connectivity (select 1,2, or 3)


Member has no peering
Member has a single peering. Specify which one: 3.Member has multiple peering. Specify whic

Member Signature
Company Seal
Member’s peering with NIXI will be (select 1or 2):
1.NIXI will be the sole peering provider to the Member. 2.Member will have multiple peering pr

BGP Information

AS number used for peering in the NIXI

List of AS Numbers the applicant would announce.


List of IP Address range the applicant would announce with NIXI.

Member Signature
Company Seal

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