Rendezvous Pipeline Company, L.L.C.

Original Volume No. 1

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Effective Date: 02/08/2007, Docket: RP07- 6-000, Status: Effective

Original Sheet No. 63 Original Sheet No. 63 : Pending

23. FORM OF TRANSPORTATION REQUEST

RENDEZVOUS PIPELINE COMPANY, L.L.C ("Transporter")

Transportation Request

Shipper Information

1. Shipper Name:_____________________________________________

(Legal Name of Party who will be signing Agreement)

(a) Requester:___________________________________________

(if other than Shipper)

2. Shipper is (Check One)

_____ End User _____ Hinshaw Pipeline

_____ LDC _____ Producer

_____ Interstate Pipeline _____ Marketer

_____ Intrastate Pipeline _____ Other:________________

(please specify)

3. Shipper's Contact Person:_________________________________

Phone Number (___)____________________________

Telecopy Number (___)____________________________

4. Address: Notices to: ___________________________________

P.O. Box & Zip: ___________________________________

Street & Zip: ___________________________________

City, State: ___________________________________

Attention: ___________________________________

Email Address: ___________________________________

Invoices to: ___________________________________

P.O. Box & Zip: ___________________________________

Street & Zip: ___________________________________

City, State: ___________________________________

Attention: ___________________________________

Service Information

5. Type of Service

(Check One): _____ FT Firm

_____ IT Interruptible

6. This request is for (Check One):_____ New Service

_____ Amendment of Existing

Service