Southern Star Central Gas Pipeline, Inc.

Original Volume No. 1

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Effective Date: 05/01/2003, Docket: RP03-352-000, Status: Effective

Original Sheet No. 477 Original Sheet No. 477 : Superseded

 

SERVICE REQUEST FORM

 

 

b. Amendment to an existing agreement #_______ Date_______ ____

 

i. change in primary receipt point(s) ____

ii. change in primary delivery point(s) ____

iii. other (describe) ____

___________________________________________________

 

2. Shipper Information:

 

a. Complete legal name of Shipper:

_________________________________________________________________

 

b. Address of Shipper:

_________________________________________________________________

_________________________________________________________________

_________________________________________________________________

_________________________________________________________________

 

c. Type of legal entity, state of incorporation and location of

principal office:

_________________________________________________________________

_________________________________________________________________

_________________________________________________________________

 

d. Type of company:

 

______Local Distribution Co. _______End-User

______Intrastate Pipeline _______Marketer

______Interstate Pipeline _______Other (fill in) ______

______Producer

 

3. Requested Form of Service:

 

______311* (284B) ______284G (Interstate)**_____284G(Other)

 

4. "On Behalf of" Entity Information

(For 311 or 284G Interstate Requests)

 

a.* Section 311 service will be "On Behalf Of," pursuant to Subpart B

of Part 284 of the Federal Regulations:

 

(Legal Name) ___________________________________, which is an:

_____LDC ______Intrastate