U S G Pipeline Company

ORIGINAL VOLUME NO. 1

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Effective Date: 04/01/2000, Docket: CP99-211-001, Status: Effective

Original Sheet No. 96 Original Sheet No. 96 : Effective

 

SERVICE REQUEST FORM

 

The estimated total quantity of gas to be transported during the

requested term of service is ___________ Dth.

 

11. If Shipper is purchasing gas, provide the location and state

(including offshore designation) of the source(s) of supply:

 

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

 

*12. If Shipper is selling gas, provide the name of purchaser(s) of the

gas, contract quantity, and the effective and termination date(s) of executed

Agreement(s) between Shipper and purchaser(s):

 

________________________________________________________________________

________________________________________________________________________

 

*This information is not required at the time of the request but is

required at the time Shipper executes the gas service contract.

 

13. The names of those entities delivering gas into Transporter's system

and the names of those entities taking gas off Transporter's system:

 

Transporter Point of Receipt Name/Delivering Entity

 

________________________________ _________________________

________________________________ _________________________

________________________________ _________________________

________________________________ _________________________