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. 97 Original Sheet No. 97 : Effective
SERVICE REQUEST FORM
14. Credit Evaluation - Provide all information required in Section 6 of
Transporter's General Terms and Conditions. Shippers requesting service under
Rate Schedule FT shall submit, with their request for service, a check or wire
transfer in an amount equal to the lesser of $10,000 or the total Reservation
Charge applicable to the proposed service for a one month period. This amount
shall be credited to Shipper's bill for the first month of the requested
transportation service. If the requested service is not available, Transporter
shall refund the entire amount of the prepayment within thirty days of
notification by Transporter that service can not be provided. All prepayments
made to Transporter are to be sent by check or wire transfer to Transporter or
Transporter's designated bank at an address to be furnished by Transporter.
15. Is requestor affiliated with USG Pipeline Company?
______ Yes ______ No
If yes, what is the percentage of affiliation? ______%
16. Is shipper affiliated with USG Pipeline Company?
______ Yes ______ No
If yes, what is the percentage of affiliation? ______%
17. Is your supplier affiliated with USG Pipeline Company?
______ Yes ______ No
If yes, what is the percentage of affiliation? ______%
18. For marketing affiliates of USG Pipeline Company only, does the cost
of gas exceed the sales price, less associated costs including transportation,
i.e. is the gas being sold at a loss?
______ Yes _________ No ______ Unknown
If so, by how much? ____________
If applicable, Shipper agrees by its signature below to provide this
information within twenty-five calendar days after the month in which
the transportation service occurred.