Midwestern Gas Transmission Company

SECOND REVISED VOLUME NO. 1

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

Original Sheet No. 184 Original Sheet No. 184 : Effective

SERVICE REQUEST FORM

9. If additional or new facilities are required to receive or deliver gas for

the transportation service requested herein, please provide a description of

facilities required, location, and requested in-service date and, if

transportation service to be provided using the new facilities is to a

customer that is located in the service area of local distribution company,

please specify the name of the local distribution company.

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10. The Transportation Quantity to be transported is __________ Dth. The

estimated total quantity of gas to be transported during the requested term

of service is __________ Dth. (These amounts do not include quantities for

Midwestern's system fuel and uses and gas lost and unaccounted for.)

11. Provide the name and a description of the Primary Receipt Point(s) into

Midwestern's system and the maximum daily quantities expressed in Dth of gas

to be delivered by Shipper for each point.

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12. Provide the name and description of the Primary Delivery Point(s) where

Midwestern will redeliver the gas and the maximum daily quantities expressed

in Dth and Mcf's of gas to be redelivered by Midwestern at each point.

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