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. 2076 Original Sheet No. 2076 : Effective

 

FORM OF SERVICE AGREEMENT

Access to the Dominion South E-SCRIPT

 

ATTACHMENT B

FORM OF AGREEMENT

Access to the Dominion South E-SCRIPT - Dominion South E-SCRIPT User Request Form

(Complete one per Person)

 

Subscriber Information:

 

Company Name: _______________________ (legal description)

 

Dominion South E-SCRIPT User Information:

 

Provide the following information on a separate Attachment B for each authorized Dominion South E-

SCRIPT User for the Company named above.

 

Dominion South E-SCRIPT User Name and Address:

Name ______________________________________

Title ______________________________________

Address Line 1 ______________________________________

Address Line 2 ______________________________________

City _______________ State ___ Zip ________

Telephone _______________ Facsimile ____________

 

Dominion South E-SCRIPT User Access Rights

 

Security rights to execute capacity release transactions implies that the individual posting

offers or bids is authorized to enter into binding contractual arrangements for Subscriber. All

Dominion South E-SCRIPT Users are provided access to the E-SCRIPT and Electronic Mail functions.

 

Security Rights (Check all that apply):

 

Access Transmit Execute

Information Only Information Contracts

Contracts ________ ________ ________

Capacity Release ________ ________ ________

Nominations, Confirmation ________ ________ ________

Allocation ________ ________

________Consistent with the Dominion South E-SCRIPT Agreement between Subscriber and

Dominion South Pipeline Company, LP, dated _____________, _____, I hereby authorize Dominion South

Pipeline Company, LP, to consider the above-named individual to be Authorized Personnel or

Designated Personnel on behalf of Subscriber, as those terms are defined in the Dominion South E-

SCRIPT Agreement. Further, I acknowledge that until this authorization is effectively terminated

in writing by Subscriber, Dominion South Pipeline Company, LP, may treat the above-named

individual as a Dominion South E-SCRIPT User with the above-noted security and access

rights.ATTEST: _______________________________

 

(Subscriber)

 

By: _________________________ Telephone: _______________________

 

Its: _________________________ Date: _____________

(Title)