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. 485 Original Sheet No. 485 : Effective

 

 

SERVICE REQUEST FORM

 

 

10. Credit Evaluation - Please provide a copy of Shipper's most recent quarterly financial

statement, which must conform with the specifications set forth in Section 25 of

Company's General Terms and Conditions, most recent annual report and Form 10K and a

complete list of all affiliates including parent and subsidiary companies.

 

11. Is requestor affiliated with Midwestern Gas Transmission Company?

______ Yes ______ No

 

12. Is Shipper affiliated with Midwestern Gas Transmission Company?

______ Yes ______ No

 

 

13. Is your supplier affiliated with Midwestern Gas Transmission Company?

______ Yes ______ No

 

 

Shipper understands that this request form, complete and unrevised as to format, must be

received by Midwestern before the service request will be accepted and processed.

 

Shipper, by its signature, certifies to Midwestern (i) that the information above is

correct and accurate and that all necessary transportation arrangements with the upstream

and downstream Transporters have been or will be secured prior to the commencement of the

requested transportation service (ii) that Shipper will have title, or the right to acquire

title, to the gas that is to be delivered to Midwestern.

 

Very truly yours,

 

 

 

_____________________________________

 

By __________________________________