Central New York Oil And Gas Company, LLC

Original Volume No. 1

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Effective Date: 12/01/2001, Docket: CP00- 61-001, Status: Effective

Original Sheet No. 121 Original Sheet No. 121 : Effective

 

SERVICE REQUEST FORM (continued)

 

For all

__________________________________________________

Other Matters

__________________________________________________

Attention: ____________________ Telephone

(____)_______________

 

Dispatch & Control Representative

_________________________________

Telephone No. (____)_____________ Telecopier

(____)________________

 

Is Customer affiliated with Seller? YES _____ NO _____

 

If yes, type of affiliation and the percentage of

ownership between Seller and Customer

_______________________________

 

5. Customer is a(n): (Check One)

_____ Local Distribution Company _____

Producer

_____ Intrastate Pipeline Company _____ End-

User

_____ Interstate Pipeline Company _____

Marketer/Broker

_____ Other (Describe)

__________________________________

 

6. Customer is Acting: (Check One)

 

_____ for Itself

_____ as Agent for

________________________________________

 

7. This request is for: (Check One)

_____ Firm Storage Service under Rate Schedule FSS

_____ Interruptible Storage Service under Rate

Schedule ISS

 

8. Requested Storage Demand Withdrawal Quantity (SDWQ)

(FSS Only)

Service Category ____

Dekatherms per day* ___________

 

* Storage Demand Withdrawal Quantity for all

firm services must be determined in accordance

with Seller's Rate Schedule FSS.

 

9. Requested Maximum Storage Quantity

 

_____ Dekatherms (Shall not be less than 100,000

dth, except for volumes under Section 7 of Rate

Schedule FSS.)