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
7. Contact Person for Request:_______________________________________