High Island Offshore System, L.L.C.

Third Revised Volume No. 1

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Effective Date: 12/15/2007, Docket: RP08- 65-000, Status: Effective

Third Revised Sheet No. 176 Third Revised Sheet No. 176 : Effective

Superseding: Second Revised Sheet No. 176

 

 

HIGH ISLAND OFFSHORE SYSTEM

TRANSPORTATION SERVICE REQUEST FORM

 

 

 

Send to: High Island Offshore System (HIOS)

P. O. Box 4324

Houston, Texas 77210-4324 Date Received ______________

Attention: Manager, Contract Administration

 

Telecopier Number: (713) 381-7996

Verification: (713) 381-7940

 

NOTE: A check, if required by Section 2.1, must accompany each Transportation

Service Request to be valid.

 

 

INFORMATION REQUIRED FOR VALID TRANSPORTATION REQUEST

 

 

1. Requester's Name and Address (Do not complete if same as Shipper, see No. 2

below):

 

____________________________________________________________________________

 

____________________________________________________________________________

 

____________________________________________________________________________

 

Requester's Affiliation With HIOS or Any Partner in HIOS:

 

____________________________________________________________________________

 

2. Shipper's Name and Address (Note: The "Shipper" is the party which proposes

to execute the Transportation Agreement with HIOS):

 

____________________________________________________________________________

 

____________________________________________________________________________

 

____________________________________________________________________________

 

Attention: _______________________________ Telephone: ______________________

 

Nature of Shipper (check one):

 

_____ Interstate pipeline

 

_____ Intrastate pipeline

 

_____ Local distribution company

 

_____ End-user

 

_____ Producer

 

_____ Marketer

 

_____ Other (explain) __________________________________