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. 347 Original Sheet No. 347 : Effective

TRANSPORTATION REQUEST FORM

(continued)

7.* The intended use of the gas is:

________ system supply

________ end use by industry or commerce

________ other (fill in)

________________________________________

8. Date service is proposed to commence:

________________________________

9. Expiration Date:

________________________________

10. If additional or new facilities are required to receive

or deliver gas for the transportation service requested

herein, please provide description of facilities

required, location, and requested in-service date.

__________________________________________________

__________________________________________________

__________________________________________________