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. 515 Original Sheet No. 515 : Effective

REQUEST FOR SERVICE

(Continued)

For items 8 and 9, list the following for each requested receipt and/or delivery point:

Note, for service under the IT -1 Rate Schedule, all points contained in the Master List of

Interconnects (MLI) as defined in Section 1 of the General Terms and Conditions are deemed to be

valid receipt and/or delivery point(s).

8.

(i) Receipt Point (ii) Dth/d

_____________ _______________

_____________ _______________

_____________ _______________

9.

(i) Delivery Point (ii) Daily Quantity

_____________ _______________

_____________ _______________

_____________ _______________

General Comments

Requestor hereby certifies that the information contained in this Request for Transportation

is complete and accurate to the best of Requestor's knowledge, information, and belief; that

transportation agreements with all downstream and upstream third-party transporters have been either

executed or requested; and that all State and Federal approvals that are necessary for gas to be

received into and delivered from Transporter's facilities have been applied for or obtained.

Requestor Company: _______________________________________

Signed By: _______________________________________________

Title ___________________________________________________

Date ___________________________________________________