Midwestern Gas Transmission Company
Third Revised Volume No. 1
Contents / Previous / Next / Main Tariff Index
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 __________________________________