Equitrans, L. P.

Original Volume No. 1

Effective Date: 05/16/2010, Docket: RP10-616-000, Status: Effective

Second Revised Sheet No. 502 Second Revised Sheet No. 502

Superseding: First Revised Sheet No. 502

SERVICE REQUEST FORM (Continued)

7. APPALACHIAN PRODUCTION INFORMATION (IF APPLICABLE)

Customer has or will obtain title to the gas quantities requested above

and has entered into or will enter into all arrangements necessary to

ensure all upstream and downstream transportation will be in place prior

to the initiation of service.

A. Has/Have permit(s) been obtained for well(s)? YES NO

B. Is/Are wells drilled? YES NO

Number drilled:

Number proposed:

Total wells:

Permit Number(s): , ,

C. Location of Well(s) Field(s):

Twp./Dist., County, & State:

D. Topographic Map Designation (USGS 7.5'):

(Please attach 8-1/2" x 11" portion of top sheet showing well(s) location

and any documents which may be helpful in processing this application,

such as description of lease(s), location sketch or plot, permit number,

completion data, farm maps, etc.)

8. CREDIT EVALUATION

Equitrans' acceptance of a request for service is contingent upon the

requesting party's satisfying a credit evaluation by Equitrans.

Please provide the following information:

A. Bank References

B. Year end financial statements together with the latest quarterly

report.

C. A list of all affiliates.

D. A statement of whether the requesting party is operating

under any bankruptcy or insolvency law or any law relating to

the relief of debtors, reorganization or creditors

assignment.

E. Such other information as Equitrans deems necessary to

evaluate the creditworthiness of the requesting party.

9. PLEASE RETURN THIS COMPLETED APPLICATION TOGETHER WITH THE

INFORMATION REQUESTED IN ITEM 8 ABOVE TO:

EQUITRANS, L.P.

c/o Gas Transportation Department

625 Liberty Avenue, Suite 1700

Pittsburgh, PA 15222-3111