Tuscarora Gas Transmission Company

Original Volume No. 1

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Effective Date: 12/01/1995, Docket: CP93-685-003, Status: Effective

Original Sheet No. 131 Original Sheet No. 131 : Effective

SERVICE REQUEST FORM FOR

TUSCARORA GAS TRANSMISSION COMPANY

(c) Primary Delivery Points (FT service only)

Maximum Equivalent Maximum and

Delivery Points Quantity Minimum Pressure

_____________ _______________ ________________

_____________ _______________ _______________

_____________ _______________ _______________

_____________ _______________ _______________

(d) Maximum Transportation Quantity: _________________

2. Date Service is Requested to Commence: _____________________________

3. Date Service is Requested to Terminate: ____________________________

4. Requesting Party (Complete Legal Name): ____________________________

____________________________________________________________________

(a) Type of Legal Entity: _________________________________________

(b) State of Incorporation: _______________________________________

(c) Shipper is (Check one):

____ Interstate pipeline ____ Intrastate pipeline

____ End-User ____ LDC

____ Marketer ____ Producer

____ Other _____________ ____ Broker