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. 522 Original Sheet No. 522 : Effective

REQUEST FOR SERVICE

REVISE RECEIPT/DELIVERY POINTS ON EXISTING AGREEMENT

1. Changes are applicable to:

Rate Schedule ______________ Agreement No. _______________

2a. Identity of Requestor

Legal Company Name __________________________________________________________________

Abbreviation or short name (if applicable)___________________________________________

Phone Number _____________________________

Facsimile Number _________________________

b. Identity of Shipper (if different than Requestor)

Written documentation must be submitted to support Requestor's legal authorization to negotiate and/or

bind the Shipper contractually.

Legal Company Name __________________________________________________________________

Abbreviation or short name (if applicable)___________________________________________

Phone Number _____________________________

Facsimile Number _________________________

3. Beginning date of requested change

______/___/______