Kinder Morgan Interstate Gas Transmission LLC

Fourth Revised Volume No. 1-A

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Effective Date: 12/28/1999, Docket: GT00- 19-000, Status: Effective

Original Sheet No. 142 Original Sheet No. 142 : Effective

 

 

 

TRANSPORTATION SERVICE REQUEST FORM

 

SHIPPER INFORMATION

 

Complete Legal Name of Shipper:______________________________

State of Incorporation:______________________________________

Taxpayer I.D. No. _____________

 

Address: ________________ For Billing:________________

________________ ________________

________________ ________________

Phone: ________________ Phone: ________________

Fax: ________________ Fax: ________________

 

For Notices: For Scheduling and

Volume Information:

(include street address for express service)

 

Contact Name: ________________ ________________

________________ ________________

________________ ________________

________________ ________________

Phone: ________________ Phone: ________________

Fax: ________________ Fax: ________________

 

Shipper is: __ Local Distribution __ Intrastate Pipeline

Company

___ Interstate Pipeline __ Producer

___ End User __ Marketer

___ Other (specify)___________________________

 

Name and full title of representative who will execute the

written firm or interruptible transportation service

agreement with Transporter (If signatory person is not an

officer, please provide written authorization for

signature.)

 

Name: _______________________________________

 

Title: _______________________________________

 

If person requesting service is an agent of Shipper, please

provide proof of authority to act as agent of Shipper and

complete the following: