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Original Sheet No. 84 Original Sheet No. 84 : Superseded


Service Request Form (continued)






Internal Use Only




1. Date and Time Request received________________________________________


2. Sufficient Data (Y/N)_________________________________________________


If no, date letter sent:______________________________________________


3. Agreement Date:_______________________________________________________


4. Agreement No.:________________________________________________________


5. Nature, if any, of Customer's affiliation with Kentucky West Virginia Gas


Company ______________________________________________________________