MidContinent Express Pipeline LLC

Original Volume No. 1

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

Original Sheet No. 314 Original Sheet No. 314

EXHIBIT A

DATED ............

Company:

Contract No.:

Delivery Point(s):

Delivery Pressure:

IBS

MDQ

Name / Location County/Parish Area State PIN No. Zone (Dth)

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

........................... ................ ..... ....... ............ .......

...........................

If any end-use facility is not directly connected to MEP, a mutually acceptable IBS monitoring Agreement

must be executed consistent with Rate Schedule IBS. If such an IBS Monitoring Agreement is not in place

as to such an end-use, then this Agreement shall not apply to that end-use facility.

Rates

-----

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

otherwise provided in a separate written agreement, which agreement must be consistent with Sections 34

or 30 of the General Terms and Conditions of this Tariff (relating to Discounting and Negotiated Rates,

respectively).