Central New York Oil And Gas Company, LLC

Original Volume No. 1

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Effective Date: 02/06/2006, Docket: RP06-171-000, Status: Effective

First Revised Sheet No. 120 First Revised Sheet No. 120 : Effective

Superseding: Superseding Original Sheet No. 120

Central New York Oil And Gas Company, LLC

SERVICE REQUEST FORM

 

Send to: Central New York Oil And Gas Company, LLC

("Seller")

Attention: Commercial Operations

Two Brush Creek Blvd., Suite 200

Kansas City, MO 64112

 

Date Received

 

Attention: Commercial Operations

Telephone: 816-842-8181

Facsimile No.: 816-531-0746

 

NOTE: A check, if required by Section 2.1, must

accompany each Storage Service Request to be

valid.

 

INFORMATION REQUIRED FOR VALID STORAGE REQUEST

 

NOTE: ANY CHANGE IN THE FACTS SET FORTH BELOW, WHETHER

BEFORE OR AFTER SERVICE BEGINS, MUST BE PROMPTLY

COMMUNICATED TO SELLER IN WRITING.

 

1. Requestor: (Do not complete if same as Customer,

see No. 3 below)

Requestor's

Name:_________________________________________________

 

2. Is Requestor affiliated with Seller? YES _____ NO _____

 

If yes, type of affiliation and the percentage of

ownership between Seller and

Requestor__________________________________

 

3. Customer's Name and Address: (Note: The "Customer" is

the party which proposes to execute the Storage

Agreement with Seller).

_______________________________________________________

__________

_______________________________________________________

__________

 

Attention: ______________________ Telephone

(____)____________________

 

Address for

_____________________________________________________

Statements

_____________________________________________________

& Invoices

_____________________________________________________

Attention: ____________________ Telephone