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. 571 Original Sheet No. 571 : Effective

REQUEST FOR SERVICE

(Continued)

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.)______________________________________