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. 340 Original Sheet No. 340

FORM OF SERVICE AGREEMENT

(APPLICABLE TO RATE SCHEDULE FTS-OSF)

EXHIBIT D

To the Agreement under Rate Schedule FTS-OSF between American Midstream

(Midla), LLC (Pipeline) and ___________________________________ (Customer)

concerning discount or negotiated rate information.

Discount Information

Dated: ______________________________________

Discounted Transportation Rate: ___________________________

Discounted Rate Effective: From: _____________ To: __________________

___ Evergreen: ___ Year-to-Year

___ Month-to-Month

Condition for Discounted Transportation Rate (check applicable condition(s)):

____ Discounted Transportation Rate applicable to specified quantities under Shipper's

Service Contract(s):

_____________ MMBtu

____ Discounted Transportation Rate applicable to specified quantities above or below

a certain level or all quantities if quantities exceed a certain level:

Discounted Transportation Rate applicable to ________ MMBtu above/below

_____________ MMBtu

or