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First Revised Sheet No. 166A First Revised Sheet No. 166A : Superseded

Superseding: Original Sheet No. 166A

TRANSPORTATION SERVICE REQUEST FORM (Continued)

Viking Gas Transmission Company

Page 8

20. Is shipper affiliated with Viking Gas Transmission Company? ______ Yes

______ No

If yes, what is the percentage of affiliation? ______%

21. Is your supplier affiliated with Viking Gas Transmission Company? ______ Yes

______ No

If yes, what is the percentage of affiliation? ______%

22. Is any of the gas to be transported subject to take-or-pay relief? ____ Yes ____ No

____ Unknown

If yes, what percentage of total contract quantity to be transported is subject to

take-or-pay? ____%

23. For marketing affiliates of Viking Gas Transmission Company only, does the cost of gas

exceed the sales price, less associated costs including transportation, i.e. is the gas

being sold at a loss? ______ Yes ______ No ______ Unknown

If so, by how much? ____________

If applicable, Shipper agrees by its signature below to provide this information within

twenty-five calendar days after the month in which the transportation service occurred.

Shipper understands that this request form, complete and unrevised as to format, must be received

by Viking before the transportation request will be accepted and processed.