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)