MidContinent Express Pipeline LLC

Original Volume No. 1

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Effective Date: 04/10/2009, Docket: RP09-136-000, Status: Effective

Original Sheet No. 310 Original Sheet No. 310

 

Request Order RO No.: .......

 

PALS REQUEST ORDER FORM

DATED ..........

 

 

Shipper: .................................. Type of Service: Park ........ Loan ........

 

Initiation Point Name(s) and PIN(s):....... MAQ RO: ...................................Dth)

 

Completion Point Name(s) and PIN(s):........ Minimum Aggregate Quantity:....................

 

Term: Start .................. End ....... PALS Agreement #: .............................

 

Schedule:

 

Date(s) Service to be Provided Daily Quantity (Dth)

(May Reflect a Range of Dates) (May Reflect a Range of Volumes)

------------------------------ ------------------------------------------------------------

Park or Loan Payback Loan or Park Delivery

From Through Minimum Maximum Minimum Maximum

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Rates: Rates may vary based on volume, time period, etc., as set out in the a Service Agreement

 

Daily PALS Usage Charge:*....................................................................

 

Service will be ON BEHALF OF:

 

...... Shipper or

...... Other: ................................................, a .........................

 

SHIPPER'S CONTACT AND ADDRESS

 

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Phone: ..................................... Fax: .......................................

 

Other Conditions (if any): ..................................................................

 

Agreed to by:

 

MIDCONTINENTAL EXPRESS PIPELINE LLC SHIPPER

 

/s/: ............................... /s/:..........................................

 

NAME: .............................. NAME: ........................................

 

TITLE: ............................. TITLE: .......................................

 

* The rate shall be the applicable maximum rate and other applicable maximum lawful charges except as

otherwise provided specified in writing, which agreement must be consistent with Section 34 or 30

of the General Terms and Conditions of this Tariff (relating to Discounting and Negotiated Rates,

respectively.)