Dominion Cove Point LNG, LP

Original Volume No. 1

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Effective Date: 12/22/2006, Docket: RP07- 36-001, Status: Effective

Second Revised Sheet No. 492 Second Revised Sheet No. 492 : Effective

Superseding: First Revised Sheet No. 492

REQUEST FOR SERVICE FORM

(Continued)

3. AFFILIATIONS

A. Is Buyer an affiliate of Dominion Cove Point LNG, LP? Yes No

B. If yes, identify: ____________________________________________

C. Is gas to be transported/liquefied purchased from a supplier/

marketer affiliated with Dominion Cove Point LNG, LP? Yes No

D. If yes, identify supplier: __________________________________

4. COMMENCEMENT DATE REQUESTED: _____/_____/_____

5. TERMINATION DATE REQUESTED: _____/_____/_____

6. FIRM QUANTITIES

A. Rate Schedule LTD-1 (MDDQ): _______________ Dth/Day

B. Rate Schedule FPS-1 (MDPQ): _______________ Dth/Day

C. Rate Schedule FPS-2 (MDPQ): _______________ Dth/Day

D. Rate Schedule FPS-3 (MDPQ): _______________ Dth/Day

E. Rate Schedule FTS (MFTQ): _______________ Dth/Day

F. Rate Schedule OTS (MFTQ): _______________ Dth/Day

7. INTERRUPTIBLE QUANTITIES

A. Rate Schedule LTD-2 (MDDQ): _______________ Dth/Day

B. Rate Schedule LTD-2 (MCSQ): _______________ Dth

C. Rate Schedule ITS (ITQ): _______________ Dth/Day

8. RECEIPT POINT(S)

A. For each requested Receipt Point, list the following:

1. Receipt Measuring Station name.

2. Quantity to be delivered to Seller (Dth/Day).

3. Name of upstream entity delivering gas.

Primary Receipt Point: 1. _____________________________

2. _____________________________

3. _____________________________

Secondary Receipt Point: 1. _____________________________

2. _____________________________

3. _____________________________