Honeoye Storage Corporation

Original Volume No. 1A

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:__________________