American Midstream (AlaTenn), LLC

Fifth Revised Volume No. 1

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Effective Date: 05/01/2010, Docket: RP10-493-000, Status: Effective

Original Sheet No. 345B Original Sheet No. 345B

FORM OF RELEASE REQUEST (continued)

3. Commencement Date and term of release including any minimum

acceptable term (may

be

stated as range of acceptable terms):

4. Primary Receipt and Delivery Points for Transportation Service:

----- Primary Receipt Points ----- Firm Capacity to be

Meter Number Meter Description Released at such point(s)

_

_

_ ________________

---- Primary Delivery Points ----- Firm Capacity to be

Meter Number Meter Description Released at such point(s)

_

_

_ ________________

5. All applicable rates, charges and surcharges for the release including a

statement as to

whether

bids based on a one part volumetric rate will be accepted (including any minimum

acceptable

rates):