Energy West Development, Inc.

Original Volume No. 1

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Effective Date: 07/01/2003, Docket: RP03-433-000, Status: Effective

Original Sheet No. 98 Original Sheet No. 98 : Effective

 

SERVICE REQUEST FORM FOR

ENERGY WEST DEVELOPMENT, INC.

 

2. Date Service is Requested to Commence: _____________________________

 

3. Date Service is Requested to Terminate: ____________________________

 

4. Requesting Party (Complete Legal Name): ____________________________

 

____________________________________________________________________

 

 

 

 

____ Interstate pipeline ____ Intrastate pipeline

 

____ End-User ____ LDC

 

____ Marketer ____ Producer

 

____ Other _____________ ____ Broker

 

If Shipper is acting as agent in arranging this service, specify below each principal (complete legal name, type

of legal entity and state of incorporation) and its respective type of company (Shipper must supply agency

agreements for each principal).

 

 

 

5. Are additional or new facilities required to be installed or constructed by any party which are necessary for

receipt of gas by Transporter or for delivery to and/or utilization of gas by the Shipper or direct or indirect

customers of the Shipper? If

 

 

 

6. Name and full title of officer (or general partner) of Shipper who will execute the Transportation Service

Agreement.

 

 

 

7. Contact Person for Request:_______________________________________

Mailing Address:__________________________________________________

__________________________________________________

Street Address:

Phone:

Telecopy No: