Kinder Morgan Interstate Gas Transmission LLC

Second Revised Volume No. 1-C

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

Original Sheet No. 28 Original Sheet No. 28 : Superseded

 

 

 

BUFFALO WALLOW 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 Company ___ Intrastate Pipeline

___ 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: ________________________________________________