American Midstream (Midla), LLC

Sixth Revised Volume No. 1

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Effective Date: 05/01/2010, Docket: RP10-483-000, Status: Effective

Original Sheet No. 327 Original Sheet No. 327

FORM OF SERVICE AGREEMENT

(APPLICABLE TO RATE SCHEDULE ITS)

EXHIBIT A

To the Agreement under Rate Schedule ITS between American Midstream (Midla), LLC

(Pipeline) and ___________________________________ (Customer) concerning

Point(s) of Receipt.

Point(s) of Receipt

Dated:______________________

Point of Maximum Daily Maximum

Receipt Receipt Obligation Receipt Pressure

Signed for Identification

American Midstream (Midla), LLC: _______________________________

Customer: _______________________________

Supersedes Exhibit A Dated: _______________________________