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. 100 Original Sheet No. 100 : Effective

SERVICE REQUEST FORM FOR

ENERGY WEST DEVELOPMENT, INC.

10. Proposed Receipt Points and Volumes (Use additional sheets if necessary):

Receipt Receipt Receipt

Point 1 Point 2 Point 3 Total

Maximum

Input

Quantity, Mcf

Maximum

Input

Quantity, Dt

Estimated Total

Input Quantities

to be Transported

Through Receipt

Point Over Term

of Service, Mcf

Estimated Total

Input Quantities

to be Transported

Through Receipt

Point Over Term

of Service, Dt

Name and Address of

Entity which will

Deliver Gas to

Transporter

on Shipper's behalf