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.)

______________________________________________________________________