Requesting Organization:
Requestor:
Role:
The requesting organization does hereby declare that the IP Address(es) listed below are:
Static IPs
Dedicated to and under the control of the Requesting Organization
Not shared between multiple business or organizations
The requesting organization understands and agrees that:
It is wholly responsible for any and all activity originating to or from the whitelisted IP Address
The IP Address will be removed from the Whitelist without notice, if TriageLogic detects any abuse or suspicious activity coming from it.
These IPs will expire from our white list every quarterly. You'll need to re-submit this form before April 1st, July 1st, Oct 1st, Jan 1st.
IP Addresses to be Whitelisted for MFA
_____ . _____ . _____ . _____
Signature of Requestor:
Date: