Great Lakes Gas Transport, L.L.C.
Second Revised Volume No. 1
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Effective Date: 11/01/1993, Docket: RP97-157-006, Status: Effective
Sub. Original Sheet No. 202 Sub. Original Sheet No. 202 : Effective
Superseding: Original Sheet No. 202
GAS TRANSPORT, INC.
TRANSPORTATION SERVICE REQUEST FORM
GAS TRANSPORT, INC. INTERNAL USE ONLY
132 EAST MAIN STREET CONTRACT #___________________
LANCASTER, OHIO 43130 REQUEST #____________________
ATTENTION TRANSPORTATION DEPARTMENT VALID _____Y______N_______
REC'D BY ____________________
FOLLOW UP____________________
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TYPE OF SERVICE - CHECK ONE ³ SERVICE - CHECK ONE
1. ______ IT (CHECK ONE) ³ 2. _____ NEW SERVICE
- TRANSMISSION ³
- GATHERING ³ _____ MODIFICATION OF EXISTING SERVICE
³
______ EFT (CHECK ONE) ³
- TRANSMISSION ³ ___________________________
- GATHERING ³ DESCRIPTION OF MODIFICATION
³
______ FT (CHECK ONE) ³
- TRANSMISSION ³
- GATHERING ³
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3. _____________________(SHIPPER) HEREBY REQUESTS FIRM/INTERRUPTIBLE
TRANSPORTATION SERVICE FROM GAS TRANSPORT, INC. (GTI) AND CONSEQUENTLY
PROVIDE THE FOLLOWING INFORMATION IN CONNECTION WITH THIS REQUEST:
4. COMPLETE LEGAL NAME OF SHIPPER
______________________________________________________________________
5. TYPE OF LEGAL ENTITY AND STATE OF INCORPORATION:
______________________________________________________________________
______________________________________________________________________
6. SHIPPER IS:
_____ LOCAL DISTRIBUTION COMPANY _____ END-USER
_____ INTRASTATE PIPELINE _____ MARKETER
_____ INTERSTATE PIPELINE _____ BROKER
_____ PRODUCER _____ OTHER (FILL IN)
_________________________
7. A. NAME OF SHIPPER CONTACT, ADDRESS AND TELEPHONE NUMBER THROUGH WHICH
CORRESPONDENCE SHOULD BE DIRECTED:
______________________________________________________________________
______________________________________________________________________
B. CONTACT FOR BILLING PURPOSES (IF DIFFERENT FROM A.)
______________________________________________________________________