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. 183 Original Sheet No. 183 : Effective

SERVICE REQUEST FORM

5. 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.

__________________________________________________________________________________

____________________________________________________________________________

6. (a) Location (i.e. state(s)) of the ultimate delivery point of gas to be

transported:

___________________________________________________________________

(b) Location (i.e. state(s)) of the origin of the gas to be transported:

____________________________________________________________________

7. Date service is proposed to commence:

_____________________________________

8. Term of service:

___________ months

___________ years