High Island Offshore System, L.L.C.

Third Revised Volume No. 1

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Effective Date: 10/01/2007, Docket: RP06-540-004, Status: Effective

Third Revised Sheet No. 177 Third Revised Sheet No. 177 : Effective

Superseding: Substitute Second Revised Sheet No. 177

 

 

Transportation Service Request Form

(Continued)

 

 

 

State in Which Shipper is Organized or Incorporated: ________________________________

 

_____________________________________________________________________________________

 

Shipper's Affiliation With HIOS or Any Member in HIOS: ______________________________

 

_____________________________________________________________________________________

 

Address for _______________________________________________________________________

Statements & _______________________________________________________________________

Invoices _______________________________________________________________________

Attention: _____________________________________ Telephone: ______________________

 

Dispatch & Control Representative ___________________________________________________

Telephone No. ____________________________ Telecopier: ____________________________

 

For All _______________________________________________________________________

Other Matters _______________________________________________________________________

Attention: _____________________________________ Telephone: ______________________

 

3. Term of Service

 

Date service is requested to commence: ______________________

 

Date service is requested to terminate: ______________________

 

4. This request is for: (Check One)

 

_____ Interruptible Service under Rate Schedule IT

 

_____ Firm Service under Rate Schedule FT-1

 

_____ Firm Service under Rate Schedule FT-2

 

 

5. Requested Maximum Daily Quantity (MDQ)

 

__________ Dth per day

 

6. Requested total quantity for initial term (MDQ x days in initial term)

 

__________ Dth

 

7 Liquids & Liquefiables

 

Is Shipper requesting transportation of Associated Liquids?

 

YES ______ NO ______

 

If yes, name and location of Processing Plant: ______________________________

 

_____________________________________________________________________________

 

(Attach a table showing associated liquids at points of receipt)