Bulk IPv4 / IPv6 Subnet Leasing - IPv6 - /29

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Additional Information
(required fields are marked with *)

This is a NUMERICAL input. This is the server provider's ASN that is going to announce our subnets for you (i.e. Level3). NOTE: We will not allow our subnets on Leaseweb (AS60781,56971). No exceptions.
What will IPs be used for?
What geolocation do you require for this subnet? We require BOTH city / country.