Nautilus Pipeline Company, LLC

Original Volume No. 1

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

Third Revised Sheet No. 328 Third Revised Sheet No. 328

Superseding: First Revised Sheet No. 328

 

SERVICE REQUEST FORM

 

If Agent, is Agent responsible for: Accounting, Invoices Y ___ N ___

Nominations, Scheduling Y ___ N ___

 

Representatives of Shipper (up to two) who are authorized to receive

notices regarding Shipper's creditworthiness, including requests for

additional information:

 

Name Email Address

 

_______________________________ ___________________________________

 

_______________________________ ___________________________________

 

 

IX. The following credit evaluation information is submitted herewith:

 

(a) Current financial statements, annual reports, 10-K reports or

other filings with regulatory agencies which discuss Shipper's

financial status;

 

(b) A list of all corporate affiliates, parent companies and

subsidiaries;

 

(c) Bank references;

 

(d) Two trade references;

 

(e) A verified statement that Shipper is not operating under any

chapter of the bankruptcy laws and is not subject to liquidation

or debt reduction procedures under state laws; and

 

(f) A verified statement that Shipper is not aware of any change in

business conditions that would cause a substantial alteration in

its financial conditions, a condition of insolvency, or the

inability to exist as an ongoing business entity, and that no

significant collection lawsuits or judgments are outstanding which

would materially affect Shipper's ability to remain solvent as a

business entity.

 

Prepayment Required

 

Shipper must submit a prepayment in the amount of $25,000 for any

firm service.