Viking Gas Transmission Company

Original Volume No. 1

Effective Date: 06/01/1991, Docket: GT91- 25-000, Status: Effective

First Revised Sheet No. 160 First Revised Sheet No. 160 : Superseded

Superseding: Original Sheet No. 160

TRANSPORTATION SERVICE REQUEST FORM

Viking Gas Transmission Company

P.O. Box 2511

Houston, Texas 77252

Attention: Director of Marketing and Transportation Services

Re: Transportation Service on _____ New Service _____ Firm

Viking Gas Transmission _____ Modification of Service _____ Interruptible

Company under Contract No. _____

Gentlemen:

___________________________ (Shipper) hereby requests transportation service on Viking Gas

Transmission Company (Viking) and concurrently provides the following information in connection

with this request:

1. Complete legal name of Shipper:

________________________________________________________________________________

2. Type of legal entity and state of incorporation:

________________________________________________________________________________

3. Type of company:

_________________ Local Distribution Company

_________________ Intrastate Pipeline

_________________ Interstate Pipeline

_________________ Producer

_________________ End-User

_________________ Marketer

_________________ Broker

_________________ Other (fill in)