Western Gas Interstate Company

Third Revised Volume No. 1

Effective Date: 06/01/1993, Docket: RS92- 53-003, Status: Effective

Revised Original Sheet No. 401 Revised Original Sheet No. 401 : Superseded

TRANSPORTATION REQUEST FORM

(continued)

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) ___________________________

4. Name of Shipper's contact, address and telephone number through

which correspondence for the following should be directed:

Contact for Request:

______________________________________