Scg Pipeline Inc.

Original Volume No. 1

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Effective Date: 11/01/2003, Docket: RP03-611-000, Status: Effective

Original Sheet No.240 Original Sheet No.240 : Superseded

AGENCY AUTHORIZATION AGREEMENT

(continued)

EXHIBIT A

TO AGENCY AUTHORIZATION AGREEMENT

BETWEEN

SCG PIPELINE, INC. CORPORATION

AND

_________________________________

Agency Authorization Agreement (Service Package Amendment ______) Dated

_____________

I. SHIPPER INFORMATION

Name: ___________________

___________________

Address: ___________________

___________________

___________________

___________________

Attn: ___________________

Phone: ___________________

Facsimile: ___________________

II. SHIPPER’S AGENT INFORMATION

Name: ___________________

___________________

Address: ___________________

___________________

___________________

___________________

Attn: ___________________

Phone: ___________________

Facsimile: ___________________

Nomination Service Package No. _____

Amendment No. _____

(Assigned by Pipeline for Shipper’s Agent’s use in nominating, confirming, and

scheduling)