Oktex Pipeline Company

Original Volume No. 1

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Effective Date: 01/01/2008, Docket: RP08- 85-000, Status: Effective

2nd Revised Sheet No. 41 2nd Revised Sheet No. 41 : Effective

Superseding: 1st Revised Sheet No. 41

 

PRO FORMA

SERVICE REQUEST FORM

 

 

REQUEST FOR TRANSPORTATION SERVICE

 

Manager, Contract Administration

OkTex Pipeline Company

100 W. 5th Street, MD 12-4

Tulsa, OK 74103

 

Attention:

 

Gentlemen:

 

_____________________________ ("Requesting Shipper") hereby requests

transportation service from OkTex Pipeline Company and hereby provides the

following information in connection with this report:

 

(a) Complete legal name of Requesting Shipper:

 

 

____________________________________________________________________

 

(b) Type of Legal entity and state of formation/incorporation:

 

 

____________________________________________________________________

 

(c) Type of Company:

 

_________________ Interstate Pipeline

_________________ Local Distribution Company

_________________ Intrastate Pipeline

_________________ Producer

_________________ End-User

_________________ Marketer

_________________ Broker

_________________ Other (fill in)

(d) (1) Name of person responsible for this request, address and

telephone number through which correspondence or other

communications should be directed. Is this person an

employee of Requesting Shipper? If not, state relationship to

Requesting Shipper.

 

 

_______________________________________________________________

_______________________________________________________________

_______________________________________________________________

 

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