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. 349 Original Sheet No. 349 : Effective

TRANSPORTATION REQUEST FORM

(continued)

14. The name of the entity delivering gas into Western's

system and the name of the entity taking gas off

Western's system;

Western Receipt Point Name/Delivering Entity

________________________ ________________________

________________________ ________________________

________________________ ________________________

Western Delivery Point Name/Taking Entity

________________________ ________________________

________________________ ________________________

________________________ ________________________