Mogas Pipeline LLC (Fomerly Missouri Interstate Gas)

First Revised Volume No. 1

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Effective Date: 06/01/2008, Docket: CP06-407-002, Status: Effective

Original Sheet No. 100 Original Sheet No. 100 : Pending

 

 

MoGas Pipeline LLC

FORM OF TRANSPORTATION SERVICE REQUEST

 

SHIPPER INFORMATION

 

Complete legal name of Shipper:________________________________

State of incorporation:__________________________________________

 

Address: _______________________ For Billing:_____________________

_______________________ _____________________

_______________________ _____________________

Phone: ________________ Phone: __________________

 

Contact information for Notices: Contact information for

scheduling and volume

information:

 

Contact Name: _______________________ ________________________

Address (include ____________________ ________________________

street address for _____________________ ________________________

hand delivery) ____________________ ________________________

Phone: _______________________ ________________________

Email Address:_______________________ ______________________________

 

Shipper is a(n) ____ Local Distribution Company ____ Intrastate Pipeline

____ Interstate Pipeline ____ Producer

____ End User ____ Marketer

____ Other (specify)___________________________________

 

Name and full title of Officer, Managing Partner, or other

authorized person(s) who will execute the written transportation

service agreement with Transporter. (If signatory person is not

an officer, please provide written authorization for signature.)

 

Name: ________________________________

Title: ________________________________

 

If person requesting service is an agent of Shipper, please

provide proof of authority to act as agent of Shipper and

complete the following:

 

Legal Name of Principal: ___________________________________,

which is a(n) ____ Local Distribution Company ____ Intrastate Pipeline

____ Interstate Pipeline ____ Producer

____ End User ____ Marketer

____ Other (specify)____________________________________