Proxy Configuration Request Form
Submit your details to request a new proxy setup or modification. Please provide accurate information for timely configuration.
Full Name
*
First Name
Last Name
Email Address
*
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Department or Team (if applicable)
Device Type
*
Please Select
Desktop/Laptop
Mobile/Tablet
Server
Other
Operating System
*
Please Select
Windows
macOS
Linux
iOS
Android
Other
Proxy Type
*
HTTP
HTTPS
SOCKS5
Other
Proxy Server Address (IP or Hostname)
*
Proxy Port Number
*
Is authentication required for this proxy?
*
Yes
No
Proxy Username (if authentication required)
Purpose of Proxy Usage
*
Please Select
Web Browsing
Application Access
Remote Access
Testing/Development
Other
Network Environment
*
Corporate/Office
Home
Public Network
Other
Preferred Configuration Method
Manual Configuration
Script/Auto-Config URL (PAC)
No Preference
Do you need access to specific sites or services via this proxy?
Yes
No
If yes, please list the specific sites or services
Additional Notes or Special Instructions
Submit Request
Should be Empty: