Western Gas Interstate Company

Fourth Revised Volume No. 1

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Effective Date: 04/01/1996, Docket: CP96- 81-006, Status: Effective

Original Sheet No. 344 Original Sheet No. 344 : Effective

TRANSPORTATION REQUEST FORM

(continued)

Gentlemen:

________________________________ ("Shipper") hereby

requests transportation service from Western Gas Interstate

Company ("Western") 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/Interstate Pipeline

__________ Producer

__________ End-User

__________ Marketer/Broker

__________ Other (fill in) ___________________________