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. 518 Original Sheet No. 518 : Effective

 

REQUEST FOR SERVICE

SHIPPER NAME OR ADDRESS CHANGE

 

1. Changes are applicable to:

 

Rate Schedule ______________ Agreement No. _______________

 

ALL ______________

 

2. Identity of Requestor

 

Legal Company Name ____________________________________________________________________

 

Abbreviation or short name (if applicable)_____________________________________________

 

Phone Number _____________________________

 

Facsimile Number _________________________

 

 

 

ADDRESSES FOR NEW AGREEMENT

 

MAILING

Street _____________________________________________________________________________________

 

City _____________________________________________________________________________________

 

State _____________________________________________________________________________________

 

Zip Code ___________________________________________________________________________________

 

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

 

 

BILLING (if different than Mailing)

 

Street _____________________________________________________________________________________

 

City _____________________________________________________________________________________

 

State _____________________________________________________________________________________

 

Zip Code ___________________________________________________________________________________

 

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