Dear SAINT Corporation,

I request an Internet security assessment on the following IP address. I certify that the specified address(es) belong to my organization and that I am authorized to request this assessment:

IP Address or Address Range:
I understand that any security scan could possibly cause instability in the host(s) that are scanned. I will hold SAINT Corporation blameless for any subsequent problems that may arise from this scan.

Signature: Date:
Printed Name: 
Title: 
Company: 

Please print out this form and fax it to (301)656-4806 or mail it to:
SAINT Corporation
4720 Montgomery Lane
Suite 800
Bethesda, MD 20814