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) ___________________________