MarkWest Pioneer, L.L.C.

Original Volume No. 1

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Effective Date: 04/01/2009, Docket: RP09-321-000, Status: Effective

Original Sheet No. 151 Original Sheet No. 151

 

MARKWEST PIONEER, L.L.C.

FORM OF TRANSPORTATION SERVICE REQUEST

 

SERVICE REQUESTED Page 2

 

Type of Service requested: ____ Firm ____ Interruptible

____ Amendment to Service Agreement dated: ___________________

 

SERVICE INFORMATION

 

Maximum Daily Quantity ________________________ MMBtu’s

 

Requested term of service:

Initial delivery date ____________________

Termination date ____________________

 

Total contract volume over life of contract

(affiliate transactions only) _____________________ MMBtu’s

 

Are additional or new facilities required for Transporter to receive or delivery Gas for the

transportation service requested herein?

______ Yes ______ No

 

If yes, state type of addition or new facilities: _______________________

 

Shipper understands that this request form, complete and unrevised as to format, and a

credit application must be received by Transporter before the request will be accepted and

processed. Shipper further understands that Transporter is an interstate pipeline subject

to the regulations of the Federal Energy Regulatory Commission (“Commission”), and that

Shipper’s request will become part of a log available for public inspection. Shipper hereby

agrees to pay Transporter’s currently effective transportation rate applicable for this

service and to comply with all applicable terms of Transporter’s Tariff. Shipper agrees

that it will reimburse Transporter for filing fees upon receipt of an invoice therefore.

 

Shipper, by its signature, represents to Transporter that the information above is correct

and accurate.

 

By: __________________________________

Signature

__________________________________

Typed Name and Title

 

Telephone Number: _________________

Facsimile Number: _________________