Viking Gas Transmission Company

First Revised Volume No. 1

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Effective Date: 01/01/2000, Docket: RP00-110-000, Status: Effective

Second Revised Sheet No. 116 Second Revised Sheet No. 116 : Superseded

Superseding: First Revised Sheet No. 116

SERVICE REQUEST FORM (Continued)

Viking Gas Transmission Company

Page 10

On Behalf of Entities

Exhibit

METER Name On Behalf of Entity*

* Local Distribution Company or Intrastate Pipeline for service under

Subpart B, Part 284.