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. 366 Original Sheet No. 366 : Effective

RELEASED CAPACITY SERVICE

REQUEST FORM

(continued)

2. Type of legal entity and state of incorporation:

________________________________________________

3. Type of company:

_____________ Local Distribution Company

_____________ Intrastate Pipeline

_____________ Interstate Pipeline

_____________ Producer

_____________ End-User

_____________ Marketer/Broker

_____________ Other (fill in)___________________________