Viking Gas Transmission Company

Original Volume No. 1

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

First Revised Sheet No. 161 First Revised Sheet No. 161 : Superseded

Superseding: Original Sheet No. 161

TRANSPORTATION SERVICE REQUEST FORM (Continued)

Viking Gas Transmission Company

Page 2

4. Name of Shipper's contact, address and telephone number through which correspondence for

the following should be directed:

Contact For Request: _______________________________

_______________________________

_______________________________

_______________________________

Contact for Notices: _______________________________

_______________________________

_______________________________

_______________________________

Contact For Invoices: _______________________________

_______________________________

_______________________________

_______________________________

5. Shipper is seeking transportation by Viking pursuant to:

a) Subpart B of the Commission's Regulations, on behalf of a local distribution

company.

____________________________________________________

Name of Company/Companies

b) Subpart B of the Commission's Regulations, on behalf of an intrastate pipeline.

____________________________________________________

Name of Company/Companies