Crossroads Pipeline Company

First Revised Volume No. 1

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Effective Date: 11/01/2001, Docket: RP02- 14-000, Status: Effective

Original Sheet No. 513 Original Sheet No. 513 : Effective

REQUEST FOR SERVICE

(Continued)

IMBALANCES (if different than Billing)

Street ____________________________________________________________________________

City ____________________________________________________________________________

State ____________________________________________________________________________

Zip Code __________________________________________________________________________

Contact Person (Mr., Mrs., Miss, Ms.) _____________________________________________

2. Type of Service Requested

(Please check where appropriate. A completed form must be submitted for each Rate Schedule

requested.)

a. Crossroads Rate Schedule -

1. FT-1 ______

2. IT-1 ______

3. PALS ______

b. Authority under which transportation is requested. Please state the appropriate subpart.

________ 1. Part 284, Subpart B (NGPA § 311) or

________ 2. Part 284, Subpart G (Blanket Certificate)

c. Transportation service is to be provided on behalf of (if different than Shipper)

___________________________________________________________________

_______ The stated party is a(n)

(Please enter the appropriate code. Note, only one can be selected.)

CODE

1 Local Distribution Company

2 Interstate Pipeline Company

3 Intrastate Pipeline Company

7 Other

_______ 3. The Shipper is a(n)

(Please enter the appropriate code.)

CODE

1 Local Distribution Company

2 Interstate Pipeline Company

3 Intrastate Pipeline Company

4 End User

5 Producer

6 Marketer

7 Other

8 Pipeline Blanket Sales Operating Unit