Dominion South Pipeline Co., LP

Original Volume No. 1

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Effective Date: 12/16/2005, Docket: CP05- 77-001, Status: Effective

Original Sheet No. 2075 Original Sheet No. 2075 : Effective

FORM OF SERVICE AGREEMENT

Access to the Dominion South E-SCRIPT

ATTACHMENT A (Cont.)

FORM OF AGREEMENT

Access to the Dominion South E-SCRIPT

E-SCRIPT Contact Information Form

(Complete one per Company)

3. Confirmation Address (Street Address and Post Office Box.)

Name ______________________________________

Title ______________________________________

Address Line 1 ______________________________________

Address Line 2 ______________________________________

City _______________ State ___ Zip ________

Telephone _______________ Facsimile ____________

4. Billing Address (Street Address and Post Office Box.)

Name ______________________________________

Title ______________________________________

Address Line 1 ______________________________________

Address Line 2 ______________________________________

City _______________ State ___ Zip ________

Telephone _______________ Facsimile ____________

5. Allocations Address (Street Address and Post Office Box.)

Name ______________________________________

Title ______________________________________

Address Line 1 ______________________________________

Address Line 2 ______________________________________

City _______________ State ___ Zip ________

Telephone _______________ Facsimile ____________