Mississippi Canyon Gas Pipeline, LLC

First Revised Volume No. 1

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Effective Date: 11/01/2009, Docket: RP10-12-000, Status: Pending

Third Revised Sheet No. 312A Third Revised Sheet No. 312A

Superseding: Second Revised Sheet No. 312A

 

EXHIBIT "B"

INTERACTIVE INTERNET WEBSITE ACCESS REQUEST FORM

 

Shipper (Complete Legal Name): _________________________________________

 

Mailing Address: ______________________________________________________

 

City:__________________________________ State: __________ Zip:__________

 

Physical Address: ______________________________________________________

 

City:__________________________________ State: __________ Zip:__________

 

DUNS No.:___________________________ Federal Tax ID: ____________________

 

Authorized Employee's/Agent's Full Name: _______________________________

E-Mail Address: ________________________________________________________

Authorized Employee's/Agent's Employer: ________________________________

Mailing

Address:_____________________City:______________State:________Zip:_______

 

Phone No.: _________________________ Fax No.: ___________________________

 

Indicate Update Capabilities for this Authorized Employee/Agent:

_____ Execute Contracts, Amendments and Accept Discounts

_____ Make Imbalance Elections/Trades

_____ Request New Service, Amendments and Discounts

_____ Receive and administer the payment of any and all invoices

_____ Submit Capacity Release Offers, Bids, Recall and Reput

_____ Submit Confirmations, PDAs, Storage Transfers

_____ Submit Nominations and Storage Transfers

_____ View only access to Interactive Internet Website screens, e-mail,

web page and reports for Shipper will be available to Shipper's

authorized employees

 

Signed by Shipper's Authorized Employee/Agent:

 

_________________________________________ Date: _____________

 

Printed Name of Shipper's Authorized Employee/Agent: ________________________

 

Approved by (Shipper):________________________________________________

 

Title: ___________________________________________ Date: ___________________

 

FOR INTERNAL USE ONLY

 

USER ID: ______________________________ Shipper# (if no DUNS): ______________

 

Security approved by:___________________ Date: _____________________________

Printed Name: _________________________

Title: ________________________________ Date:________________________

 

 

PLEASE FAX COMPLETED FORM TO (832) 214-5791