Midwestern Gas Transmission Company

SECOND REVISED VOLUME NO. 1

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

Original Sheet No. 182 Original Sheet No. 182 : Effective

 

 

 

SERVICE REQUEST FORM

 

 

3. Type of company:

 

 

__________________ Local Distribution Company

__________________ Intrastate Pipeline

__________________ Interstate Pipeline

__________________ Producer

__________________ End-User

__________________ Marketer

__________________ Broker

__________________ Other (fill in)

 

4. Name of Shipper's contact, address and telephone number through which

correspondence for the following should be directed:

 

Contact For Request: _______________________________

________________________________

________________________________

________________________________

 

Contact for Notices: _______________________________

________________________________

________________________________

________________________________

 

 

Contact For Invoices: _______________________________

_______________________________

_______________________________

_______________________________

 

 

 

 

(Midwestern reserves the right to require proof that Shipper's request meets the

requirements of the applicable Commission regulations.)