National Fuel Gas Supply Corporation

Third Revised Volume No. 1

 Contents / Previous / Next / Main Tariff Index

Effective Date: 08/01/1993, Docket: RS92- 21-001, Status: Effective

Original Sheet No. 257 Original Sheet No. 257 : Superseded

Page of

NATIONAL FUEL GAS SUPPLY CORPORATION ("NFGSC")

CUSTOMER NOMINATION FORM

For Transportation and Storage Services

I. GENERAL INFORMATION DATE OF NOMINATION ___________________

EFFECTIVE DATE ___________________

NFGSC SHIPPER NAME _____ ____ Check her for ONE DAY nomination only

CONTRACT No. _____

CONTRACT (1) _____ NOMINATIONS SHOULD BE SENT TO:

contract (2) _____

TELEPHONE # _____ National Fuel Gsa Supply Corporation

TELECOPY # _____ % Gas Supply Department

10 Lafayette Square

SIGNED _____ Buffalo, NY 14203

Phone (716)857-7233 Fax (716)857-7823

II. RECEIPT POINT ON NFGSC (Pipeline,Production Meter, or Storage

Service)

Column

(1) (2) (3) (4) (5) (6) (7)

Meter No. Upstream Upstream Upstream Previous Current Change

(if not Pipeline/ Producer/ Shipper Nomina- Nomina-

available Entity Marketer Contract tion tion

list No. (if (MMBtu/ (MMBtu/

meter applicable day) day)

name)

1._______ ________ ________ __________ _________ ________ _______

2._______ ________ ________ __________ _________ ________ _______

3._______ ________ ________ __________ _________ ________ _______

4._______ ________ ________ __________ _________ ________ _______

5._______ ________ ________ __________ _________ ________ _______

6._______ ________ ________ __________ _________ ________ _______

7._______ ________ ________ __________ _________ ________ _______

8._______ ________ ________ __________ _________ ________ _______

9. Use extra sheets if necessary

(8) TOTAL Receipts _________ ________ _______

Fuel Retained (0.02 x Receipt Nomination)_________ ________ _______

IF APPLICABLE, Storage Surface Operating Allowance

(0.014 x Receipt Nomination)_________ ________ _______

(13) TOTAL Delivered_________ ________ _______

III. DELIVERY POINT (ONE PER FORM)

(9) (10) (11) (12)

Downstream

Meter Number Downstream Downstream Shipper

(if not available, Pipeline/ Shipper Contract No. or

list meter name Entity NFGDC Poolname

__________________ ___________ __________ _______________