Midwestern Gas Transmission Company

Third Revised Volume No. 1

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Effective Date: 01/01/2002, Docket: RP02- 72-000, Status: Effective

Original Sheet No. 484 Original Sheet No. 484 : Effective

 

 

SERVICE REQUEST FORM

 

 

4. If Shipper is requesting service be performed by Midwestern for Shipper acting as

agent for another entity, please specify the full legal name of such entity.

 

__________________________________________________________________________________

 

__________________________________________________________________________________

 

5. Date service is proposed to commence:

 

__________________________________________________________________________________

 

6. Term of service:

 

________ months

 

________ years

 

7. If additional or new facilities are required to receive or deliver gas for the

transportation service requested herein, please provide a description of facilities

required, locations, and requested in-service date and, if transportation service to

be provided using the new facilities is to a Shipper that is located in the service

area of local distribution company, please specify the name of the local distribution

company.

 

______________________________________________

 

______________________________________________

 

______________________________________________

 

______________________________________________

 

8. Provide the name and a description of the Primary Receipt Point(s) into Midwestern's

system and the Maximum Daily Quantities expressed in Dekatherms of gas to be delivered

by Shipper for each point.*

 

_______________________________________________________________________________

 

_______________________________________________________________________________

 

 

9. Provide the name and description of the Primary Delivery Point(s) where Midwestern

will redeliver the gas and the Maximum Daily Quantities expressed in Dekatherms and

Mcf's of gas to be redelivered by Midwestern at each point.*

 

_______________________________________________________________________________

 

_______________________________________________________________________________

 

 

 

 

 

 

 

 

*These amounts do not include quantities for Midwestern's system fuel and uses and gas

lost and unaccounted for.