Ozark Gas Transmission, L. L. C.

Original Volume No. 1

Effective Date: 02/15/2006, Docket: RP06-207-000, Status: Effective

Second Revised Sheet No. 97 Second Revised Sheet No. 97 : Effective

Superseding: Substitute First Revised Sheet No. 97

GENERAL TERMS AND CONDITIONS (continued)

18. SERVICE REQUEST FORM

Ozark Gas Transmission, L.L.C. Facsimile: (918) 398-2165

1437 South Boulder Telephone: (918) 496-4968

Suite 1501

Tulsa, OK 74119

Attention: Amy Nance

Re: _______New Service ______Firm Transmission Service

or ______Firm Storage Service

_______Modification ______No-Notice Service

of Existing Service ______Interruptible Transportation Service

______Interruptible Storage Service

______Park and Loan Service

(Description of existing service to be modified:

Contract No. ___________________________________

________________________________________________

________________________________________________)

Gentlemen:

_____________("Shipper") hereby requests transportation service from Ozark Gas Transmission, L.L.C.

("Ozark") and concurrently provides the following information in connection with this request:

1. Complete legal name and principal place of business of Shipper:

2. Type of company:

__________Local Distribution Company

__________Intrastate Pipeline

__________Interstate Pipeline

__________Producer

__________End-User

__________Marketer

__________Broker

__________Other (fill in)