Central New York Oil And Gas Company, LLC

Original Volume No. 1

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Effective Date: 02/01/2007, Docket: CP07- 15-001, Status: Effective

Third Revised Sheet No. 122 Third Revised Sheet No. 122 : Effective

Superseding: Superseding Second Revised Sheet No. 122

 

SERVICE REQUEST FORM (continued)

 

11. Requested Point(s) of Injection/Withdrawal (identify as

applicable):

 

TGP Interconnect _____________

 

 

12. Requested South Lateral Quantity:

 

Dekatherms per day ___________ (equal to FSS Maximum Daily

Withdrawal Quantity)

 

13. Term of Service:

 

Date service is requested to commence:

________________________

 

Date service is requested to terminate:

_______________________

 

14. Rate Information (Provide rate customer will agree to pay for

service requested):

 

FIRM

 

Capacity Reservation Rate - Monthly $________ per dth

Injection Rate $________ per dth

Withdrawal Rate $________ per dth

South Lateral Reservation Rate - Monthly $________ per dth

Overrun Injection Rate $________ per dth

Overrun Withdrawal Rate $________ per dth

Base Gas Rate $________ per dth

 

INTERRUPTIBLE

 

Interruptible Storage Rate $________ per

dth-day

 

15. Certified Statement:

By submitting this request, Customer certifies that Customer

has or will have by the time of execution of an Agreement

with

Seller, title to, or the legal right to cause to be delivered

to Seller, for Storage, the Gas which is to be stored and

facilities or contractual rights which will cause such Gas to

be delivered to and received from Seller.

 

16. Credit Evaluation: as required by Section 2.2(h) of the

General Terms and Conditions.

 

THIS STORAGE SERVICE REQUEST IS HEREBY SUBMITTED

this _____ day of ____________________, ______.

By: ___________________________________________

Telephone Number: (____)________________________