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. 367 Original Sheet No. 367

 

*16. If Customer is not a local distribution company and is selling gas, provide the

name of purchaser(s) of the gas, contract quantity, and the effective and termination

date(s) of executed Agreement(s) between Customer and purchaser(s):

__________________________________________________________________

_____

__________________________________________________________________

_____

 

17. Is Customer affiliated with American Midstream (Midla), LLC?

Yes No

 

18. Is your supplier affiliated with American Midstream (Midla), LLC?

Yes No

 

19. For marketing affiliates of American Midstream (Midla), LLC, does the cost of gas

exceed the sales price, less associated costs including transportation, i.e., is the gas

being sold at a loss?

 

If so, by how much?

_________________________________________________________

 

(If applicable, Customer agrees by its signature to provide this information within twenty-

five (25) days after the month in which the transportation service occurred)

 

 

Customer will be required to meet the creditworthiness provisions of Transporter

prior to commencement of service.

 

Customer, by its signature, certifies to Pipeline (1) that the information above is

correct and accurate and that all necessary transportation arrangements with the

upstream and downstream Pipelines have been or will be secured prior to the

commencement of the requested transportation service, (2) that Customer will have title,

or the right to acquire title, to the gas that is to be delivered to Pipeline and (3) Customer

will be in compliance with the title provisions of Pipeline?s F.E.R.C. Gas Tariff.

 

 

 

By:

Its:

Date:

 

 

*This information is not required at the time of the request but is required at the

time Customer executes the Gas Transportation Contract.