Granite State Gas Transmission, Inc.

Fourth Revised Volume No. 1

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Effective Date: 03/01/2010, Docket: RP10-322-000, Status: Effective

Original Sheet No. 186 Original Sheet No. 186

FORM FOR REQUEST FOR TRANSPORTATION SERVICE

(Continued)

(h) The maximum daily quantity to be transported is

____________ Dth with an estimated total quantity of gas to be

transported during the requested term of service of ____________

Dth.

(i) Term

(1) Date service is proposed to commence _________.

(2) Term of Service _______ months, _______ years.

(3) Date of termination ___________________.

(4) Evergreen? yes ________ no ________.

(j) Name and detailed description of Receipt Point(s) into

Transporter's system and the maximum daily quantities of gas to be

delivered by Shipper for each point:

Receipt Upstream

Point MDRO Term Transp. Supplier

________ ________ ________ ________ ________

________ ________ ________ ________ ________

Name and detailed description of Delivery Point(s)

where Transporter will redeliver the gas and the maximum

daily quantities of gas to be redelivered by Transporter for

each point:

Name of End Use

Delivery Party Location

Point MDRO Term Recv Gas (State)

________ ________ ________ ________ ________

________ ________ ________ ________ ________

(k) Type of service requested:

________ Firm - FT-1

________ Firm - FT-NN

________ Interruptible -IT-1