Viking Gas Transmission Company

Original Volume No. 1

Effective Date: 11/01/1993, Docket: RS92- 52-001, Status: Effective

Original Sheet No. 110 Original Sheet No. 110 : Superseded

TRANSPORTATION SERVICE REQUEST FORM (Continued)

Viking Gas Transmission Company

Page 4

If DOE authorization has been applied for, please state:

i. Date of Application _________________________________

ii. Volume to be Imported _________________________________

iii. Current Status _________________________________

* 7. If Shipper is requesting service be performed by Viking for Shipper acting as agent for

another entity, please specify the full legal name of such entity.

_____________________________________________________________________________________

8. a) Location (i.e. state(s)) of the ultimate delivery point of gas to be transported:

_____________________________________________________________________________________

b) Location (i.e. state(s)) of the original source of the gas to be transported:

_____________________________________________________________________________________

*c) The intended use of the gas is:

______________ system supply for _________________

______________ end use by industry or commerce

______________ other (fill in)

and, if the gas is for other than system supply, please provide the full legal name of

the ultimate consumer:

_____________________________________________________________________________________

* This information is not required at the time of the request, but is required at the time

Shipper executes the Gas Transportation Agreement.