Trailblazer Pipeline Company

Fourth Revised Volume No. 1

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Effective Date: 10/11/2009, Docket: RP09-858-001, Status: Effective

Substitute First Revised Sheet No. 301 Substitute First Revised Sheet No. 301

Superseding: Original Sheet No. 301

EXHIBIT A

DATED ............

EFFECTIVE ............

Shipper:

Contract No.:

Receipt Point(s):

MDQ

Name / Location County / Area State PIN No. (Dth)

---------------------------------------------- ------------------ ----- ------- -------

PRIMARY RECEIPT POINT(S):

.............................................. .................. ..... ....... .......

..............................................

..............................................

..............................................

SECONDARY RECEIPT POINT(S):

.............................................. .................. ..... ....... .......

..............................................

..............................................

..............................................

Receipt Pressure, Assumed Atmospheric Pressure

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Natural gas to be delivered to Trailblazer at the Receipt Point(s) shall be at a delivery pressure

sufficient to enter Trailblazer's pipeline facilities at the pressure maintained from time to time,

but Shipper shall not deliver gas at a pressure in excess of the Maximum Allowable Operating Pressure

(MAOP) stated for each Receipt Point in Trailblazer's Catalog of Points. The measuring party shall use

or cause to be used an assumed atmospheric pressure corresponding to the elevation at such Receipt

Point(s).

Rates

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Except as provided to the contrary in any written agreement(s) between the parties in effect

during the term hereof, Shipper shall pay Trailblazer the applicable maximum rate(s) and all other

lawful charges as specified in Trailblazer's applicable rate schedule. Shipper and Trailblazer may

agree that Shipper shall pay a rate other than the applicable maximum rate so long as such rate is

between the applicable maximum and minimum rates specified for such service in the Tariff.

Trailblazer and Shipper may agree that a specific discounted rate will apply only to certain

volumes under the agreement. The parties may agree that a specified discounted rate will apply only

to specified volumes (MDQ or commodity volumes) under the agreement; that a specified discounted

rate will apply only if specified volumes are achieved or only if the volumes do not exceed a

specified level; that a specified discounted rate will apply only during specified periods of the

year or for a specifically defined period; that a discounted rate shall not apply to Access

Requests received after a specified time in the nomination cycle; that a specified discounted rate

will apply only to specified points or other defined geographical area(s); and/or that a specified

discounted rate(s) will apply in a specified relationship to the volumes actually transported

(i.e., that the reservation charge will be adjusted in a specified relationship to volumes actually

transported). Notwithstanding the foregoing, no discount agreement may provide that an agreed

discount as to a certain volume level will be invalidated if the Shipper transports an incremental

volume above that agreed level. In addition, the discount agreement may include a provision that

if one rate component which was at or below the applicable maximum rate at the time the discount

agreement was executed subsequently exceeds the applicable maximum rate due to a change in

Trailblazer's maximum rates so that such rate component must be adjusted downward to equal the