Honeoye Storage Corporation

Original Volume No. 1A

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Effective Date: 04/01/2007, Docket: RP07-182-000, Status: Effective

First Revised Sheet No. 124 First Revised Sheet No. 124 : Effective

Superseding: Original Sheet No. 124

HONEOYE STORAGE CORPORATION

 

SERVICE REQUEST FORM

 

Send to: Honeoye Storage Corporation

4511 Egypt Road

Canandaigua, NY 14424

Date Received:

Attention: Vice President of Operations

Telecopier No.: 585-229-2015

Verification: 585-229-5161

 

NOTE: A check, if required by Section 2.1 of the General Terms and Conditions,

must accompany each Storage Service Request to be valid.

 

INFORMATION REQUIRED FOR VALID STORAGE REQUEST

 

NOTE: ANY CHANGES IN THE FACTS SET FORTH BELOW, WHETHER

BEFORE OR AFTER SERVICE BEGINS, MUST BE PROMPTLY

COMMUNICATED TO SELLER IN WRITING.

 

1. Requestor:(Do not complete if same as Customer, See No. 3 below)

Requestor’s Name:______________________________________________

 

2. Is Requestor affiliated with Seller? YES______ NO_______

 

If yes, type of affiliation and the percentage of ownership between Seller and Requestor

______________________________

 

3. Customer’s Name and Address: (Note: The “Customer” is the party which proposes to

execute the Storage Agreement with Seller).

_________________________________________________________________

_________________________________________________________________

 

Attention:___________________________ Telephone:_____________________

Fax No.:____________________________ Email address:__________________