Western Gas Interstate Company

Third Revised Volume No. 1

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

Revised Original Sheet No. 421 Revised Original Sheet No. 421 : Superseded

RELEASED CAPACITY SERVICE

REQUEST FORM

(continued)

3. Type of company:

__________ Local Distribution Company

__________ Intrastate Pipeline

__________ Interstate Pipeline

__________ Producer

__________ End-User

__________ Marketer/Broker

__________ Other (fill in) ___________________________

4. Name of individual authorized by Bidding Shipper to submit this

Request, and the address and telephone number through which

correspondence for the following should be directed:

Contact for Request:

______________________________________

Contact for Notices:

______________________________________