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)