Nautilus Pipeline Company, LLC

Original Volume No. 1

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Effective Date: 04/05/2010, Docket: RP10-475-000, Status: Effective

Sixth Revised Sheet No. 327 Sixth Revised Sheet No. 327

Superseding: Fourth Revised Sheet No. 327

 

SERVICE REQUEST FORM

 

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

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

Nautilus' Transportation Services, at 1100 Louisiana, Suite 3300, Houston,

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

request is contingent upon a satisfactory credit appraisal by Nautilus in

accordance with Section 10 of the "General Terms and Conditions" of its FERC

Gas Tariff.

 

Date of Request: _______________________

 

I. Shipper (Full Legal Name): ___________________________________________

 

Shipper Address: ____________________________________________________

____________________________________________________

Telephone No.: __________________________

Fax No.: __________________________

Email address: __________________________

Contact Name/Department: _____________________________________________

 

Shipper's Federal Tax ID # ____________________

Shipper's DUNS # ____________________

State of Incorporation: ____________________

 

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

(Other type of Service) ______________________________________________

 

Modifying Existing Service?: ___Y ___ N

 

 

II. Production Platform (Block No.): _____________

 

III. Transportation Rate Requested: _______________________________

 

IV. Maximum Daily Quantity (MDQ) Requested: ______________________ Dth

Dates of Service: Commencing ______________ Ending _____________

 

V. Receipt Point(s): All or specify____________________________

Delivery Point(s): All or specify____________________________

 

VI. Liquids Transportation Agreement required? (please check):

Y ___ (Block No.______) N ___

 

VII. Nautilus Onshore Separation Agreement required? (please check):

Y ___ N ___

 

VIII. Agent ( ) or Marketer ( ):

____________________________________________________

Address: ___________________________________________

Telephone No.: ________________

Fax No.: _________________

Email address: ________________