Crossroads Pipeline Company
First Revised Volume No. 1
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Effective Date: 11/01/2001, Docket: RP02- 14-002, Status: Effective
Original Sheet No. 564 Original Sheet No. 564 : Effective
REQUEST FOR SERVICE
NEW AGREEMENT
1.a. 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 _________________________
ADDRESSES FOR NEW AGREEMENT
MAILING
Street
__________________________________________________________________________
City
__________________________________________________________________________
State ______________
Zip Code ____________
Contact Person (Mr., Mrs., Miss, Ms.)______________________________________