Western Gas Interstate Company

Third Revised Volume No. 1

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

Revised Original Sheet No. 403 Revised Original Sheet No. 403 : Superseded

TRANSPORTATION REQUEST FORM

(continued)

6. If shipper is requesting service be performed by Western for

Shipper acting as agent for another entity, please specify the

full legal name and address of such entity.

__________________________________________________

__________________________________________________

__________________________________________________

__________________________________________________

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:

________________________________