Nora Transmission Company

First Revised Volume No. 1

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Effective Date: 04/01/1994, Docket: CP93-568-002, Status: Effective

Original Sheet No. 301 Original Sheet No. 301 : Superseded

Service Request Form (Continued)

(d) Contact Person for Request:_____________________________________

Mailing Address:________________________________________________

Street Address:_________________________________________________

Phone:__________________________________________________________

Telecopy No.:___________________________________________________

24-hour contact person for purposes of dispatching gas to and

from receipt and delivery points:_______________________________

________________________________________________________________

Phone:__________________________________________________________

Telecopy No.:___________________________________________________

1. Is this person an employee of Customer? ____ Yes ____ No

2. If no, state relationship to Customer_______________________

Agreement information:

Notices to:___________________ Invoice to:__________________

(address)_____________________ (address)____________________

______________________________ _____________________________

Attn:_________________________ Attn:________________________