Eastern Shore Natural Gas Company

Second Revised Volume No. 1

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Effective Date: 11/01/1997, Docket: CP96-128-004, Status: Effective

Original Sheet No. 259 Original Sheet No. 259 : Effective

EASTERN SHORE NATURAL GAS COMPANY

SERVICE REQUEST FORM

(Continued)

4. If requesting firm service, Requesting Party must comply with

the prepayment provisions of Section 11(d) of the General

Terms and Conditions of Seller's FERC Gas Tariff.

Signature of Requesting Party: _______________________________

Typed or Printed Name of Requesting Party:_________________________

Title of Requesting Party: ________________________________