Equitrans, L. P.

Original Volume No. 1

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Effective Date: 06/01/2006, Docket: RP05-164-006, Status: Effective

2nd Substitute Revised Sheet No. 504 2nd Substitute Revised Sheet No. 504 : Effective

Superseding: Substitute First Revised Sheet No. 504

APPALACHIAN GATHERING SERVICE

REQUEST FORM (Continued)

RECEIPT AND GATHERING AGGREGATION POINTS REQUESTED:

A. RECEIPT POINTS

POINT NUMBER* POINT NAME GQ ALLOCATION*

______________ _______________________ _________________

______________ _______________________ _________________

______________ _______________________ _________________

______________ _______________________ _________________

______________ _______________________ _________________

______________ _______________________ _________________

*Refer to list provided by Equitrans.

B. GATHERING AGGREGATION POINTS

POOL NAME GQ ALLOCATION*

PA South ________________

WV West ________________

WV South ________________

WV North ________________

WV East ________________

*To be provided by Customer.

5. REQUESTED TERM OF SERVICE:

Commencement Date: ______________ Termination Date: ______________

Agreement will continue in effect for a primary period of one year

and thereafter monthly subject to a thirty (30) day written

cancellation notice by either party.

6. CREDIT EVALUATION (NEW SERVICE ONLY)

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.