Arlington Storage Company, LLC

Original Volume No. 1

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Effective Date: 08/24/2009, Docket: RP09-872-001, Status: Effective

Substitute Original Sheet No. 244 Substitute Original Sheet No. 244

Superseding: Original Sheet No. 244

 

Exhibit A

to the Hub Services Agreement

between ASC and________________ (Customer)

 

CUSTOMER: ___________________, pursuant to the Hub Services Agreement executed by Customer

and ASC, hereby directs and requests ASC, as Hub Administrator, to do the following:

 

Title Transfer: (from) Title Transfer: (to)

Company Name: ___________________________ Company Name:_______________________

Address____________________________________ Address:____________________________

___________________________________ __________________________________

Phone:______________ Fax:__________________ Phone:______________ Fax:__________________

 

 

POINT(S) OF RECEIPT FOR TITLE TRANSFERS

 

Flow Date Pipeline Location Volume

Name Meter Name & Meter Number (Dth/d)

 

_________ _________________ _________________________ _______

_________ _________________ _________________________ _______

_________ _________________ _________________________ _______

 

 

Shipper's Name Shipper's

Contract

Number

____________ __________

____________ __________

 

 

POINT(S) OF DELIVERY FOR TITLE TRANSFERS

 

Flow Date Pipeline Location Volume

Name Meter Name & Meter Number (Dth/d)

 

_________ _________________ _________________________ _______

 

_________ _________________ _________________________ _______

 

_________ _________________ _________________________ _______

 

 

Shipper's Name Shipper's

Contract

Number

____________ __________

 

____________ __________

 

 

Comments:________________________________________________________________

_________________________________________________________________________

_________________________________________________________________________

_________________________________________________________________________