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847-854-4799  
  950 Oak Street, Lake in the Hills, Illinois 60156
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Customer Static Route/IP address Request Form

To request initiation or modification of DLS IP address assignment, please fill out the following form completely. Fields with * are required for processing. Please see the Static Routing Policy page before filling out this form. When you change any of the Static IP Addresses or DLS Gateway Routes fields a new row will appear (up to 10). Note that you can CC yourself on this mail, so that you may receive a copy of your submission.

Once submitted, your order will be submitted to our sales department and you will be contacted regarding your request.

FROM:  (Your E-Mail)*
TO: DLS Internet support Team
CC:
SUBJECT: Static Route Request

1. Contact Information:
Contact Name: *
Company Name: *
Contact's Phone #: *
Contact Hours:
2. Your Account Information:
DLS Customer Account #: *
3. Static IP Addresses:
Provider IP Address
4. DLS Gateway Routes:
Please enter the prefixes that you wish to add or delete. If you wish to modify an existing static route, you must first delete the existing route then add the new route(s).
add / delete Prefix Subnet Mask
5. Additional Comments:

Should you need assistance filling out this form, please contact our sales department at 847.854.4799