Midwestern Gas Transmission Company

SECOND REVISED VOLUME NO. 1

Effective Date: 09/01/1993, Docket: RS92- 41-003, Status: Effective

Original Sheet No. 181 Original Sheet No. 181 : Effective

SERVICE REQUEST FORM

Midwestern Gas Transmission Company

P.O. Box 2511

Houston, Texas 77252

Attention: Director of Marketing and Transportation Services

Re: Service on _____ New Service _____ Firm-FT-A ______ LMS-MA

Midwestern Gas _____ Modification of _____ Firm-FT-GS ______ LMS-PA

Transmission Service

Company _____ Interruptible ______ PL Bal.

Agmt.

___________________________ (Shipper) hereby requests transportation service on

Midwestern Gas Transmission Company (Midwestern) and concurrently provides the

following information in connection with this request:

1. Complete legal name of Shipper:

_______________________________________________________________________

2. Type of legal entity and state of incorporation:

_________________________________________________________________________________