Equitrans, L. P.

Original Volume No. 1

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

Third Revised Sheet No. 505 Third Revised Sheet No. 505

Superseding: Second Revised Sheet No. 505

APPALACHIAN GATHERING SERVICE

REQUEST FORM (Continued)

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.

7. PLEASE RETURN THIS COMPLETED APPLICATION BY______________ TO YOUR

TRANSPORTATION AND EXCHANGE REPRESENTATIVE AT THE ADDRESS BELOW OR

FAX TO (412) 395-3347.

EQUITRANS, L.P.

625 Liberty Avenue, Suite 1700

Pittsburgh, PA 15222-3111