Kentucky West Virginia Gas Company

Third Revised Volume No. 1

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Effective Date: 07/01/1993, Docket: RS92- 18-002, Status: Effective

Original Sheet No. 79 Original Sheet No. 79 : Superseded

K.W. Request No. _____

KENTUCKY WEST VIRGINIA GAS COMPANY

REQUEST FORM FOR

SERVICE UNDER

RATE SCHEDULES FGS, FTS, IGS, ITS

I

Type of service requested: (check one)

_____ Firm gathering service (FGS)

_____ Firm transportation service (FTS)

_____ Interruptible gathering service (IGS)

_____ Interruptible transportation service (ITS)

II

(a) Requesting Party (Complete Legal Name of Customer): _______________

___________________________________________________________________

(b) Type of Legal Entity: __________________________________________

State of Incorporation: _______________________________________

(c) Customer is: (Check one of the below)

a. _____ Intrastate d. _____ End-User g. _____ Broker

b. _____ LDC e. _____ Producer h. _____ Other _____

c. _____ Hinshaw f. _____ Marketer