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. 526 Original Sheet No. 526 : Effective

 

REQUEST FOR SERVICE

INCREASE IN QUANTITY OF AN 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. 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