Mississippi Canyon Gas Pipeline, LLC

First Revised Volume No. 1

 Contents / Previous / Next / Main Tariff Index

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

Fourth Revised Sheet No. 314 Fourth Revised Sheet No. 314

Superseding: Third Revised Sheet No. 314

SERVICE REQUEST FORM (Continued)

VII. Receipt Point(s): ____________________________

Delivery Point(s): ____________________________

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

for the transportation service requested herein, please provide

description of facilities required, location and requested in-service

date:

________________________________________________________________________

________________________________________________________________________

IX. Agent ( ) or Marketer ( ):

____________________________________________________

Company Name: ______________________________________

Address: ___________________________________________

________ ___________________________________________

Telephone No.: ________________

Fax No.: _________________

E-mail address: ________________

If Agent, is Agent responsible for: Accounting, Invoices Y ___ N ___

Nominations, Scheduling Y ___ N ___

X. Credit Evaluation - A Shipper seeking service from Transporter under

Rate Schedules FT-1, FT-2 or IT-1 must comply with the creditworthiness

criteria as described in the General Terms and Conditions of the

Mississippi Canyon Tariff.

Representatives of Shipper (up to two) that are authorized to receive

notices regarding Shipper's creditworthiness, including requests for

additional information:

Name E-Mail Address

_______________________ ________________________

_______________________ ________________________

XI. Shipper understands that this request form, complete and unrevised as to

format, must be received by Transporter before the transportation

request will be accepted and processed.