Garden Banks Gas Pipeline, LLC

Original Volume No. 1

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Effective Date: 05/10/2010, Docket: RP10-594-000, Status: Effective

Sixth Revised Sheet No. 297 Sixth Revised Sheet No. 297

Superseding: Fifth Revised Sheet No. 297

FORM OF SERVICE REQUEST FORM

Requests for service under Garden Banks' FERC Gas Tariff shall be deemed valid

only after the following information is provided by Shipper in writing to

Garden Banks' Contract Administration, at 1100 Louisiana, Suite 3300, Houston,

Texas 77002, via email to, or Facsimile Number (832) 214-5791. Acceptance of a

request is contingent upon a satisfactory credit appraisal by Garden Banks in

accordance with Section 34 of the "General Terms and Conditions" of its FERC

Gas Tariff.

Date of Request: _______________________

I. Shipper (Full Legal Name): ___________________________________________

Contact Name/Department: _____________________________________________

Shipper Address: ____________________________________________________

____________________________________________________

Telephone No.: __________________________

Facsimile No.: __________________________

Email address: __________________________

II. Type of legal entity and state of incorporation:

_______________________________________________

_______________________________________________

III. Type of company:

_____ Interstate Transporter

_____ Local Distribution Company

_____ Intrastate Transporter

_____ Producer

_____ End-User

_____ Marketer

_____ Broker

_____ Other (describe)_____________________________________

Shipper's Federal Tax ID # ____________________

Shipper's DUNS # ____________________

Type of Service (circle one) FT-1 FT-2 FT-3 IT-1

(Other type of Service) ______________________________________________

Modifying Existing Service?: ___Y ___ N

Transportation Rate Requested: _______________

IV. Production Platform (Block No.): _____________