T.W. Phillips Pipeline Corp.

Original Volume No. 1

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Effective Date: 01/01/2010, Docket: RP10-141-000, Status: Effective

Original Sheet No. 101 Original Sheet No. 101

 

T. W. PHILLIPS PIPELINE CORP.

FORM OF TRANSPORTATION SERVICE REQUEST

 

SERVICE REQUESTED Page 2

 

Type of Service requested: _______ Firm _______ Interruptible

_______ Amendment to Service Agreement dated:______________________________________

 

SERVICE INFORMATION

 

Maximum Daily Quantity _____________________________________MMBtu’s

 

Requested term of service:

Initial delivery date __________________________________

Termination date __________________________________

 

Total contract volume over life of contract

(affiliate transactions only ) __________________________________MMBtu’s

 

Are additional or new facilities required for Transporter to receive or delivery of Gas for the

transportation service requested herein?

________ Yes ________ No

 

If yes, state type of addition or new facilities:____________________________________________

 

Shipper understands that this request form, complete and unrevised as to format, and a credit

application must be received by Transporter before the request will be accepted and processed.

Shipper further understands that Transporter is an interstate pipeline subject to the regulations

of the Federal Energy Regulatory Commission (“Commission”), and that Shipper’s request will

become part of a log available for public inspection. Shipper hereby agrees to pay Transporter’s

currently effective transportation rate applicable for this service and to comply with all

applicable terms of Transporter’s Tariff. Shipper agrees that it will reimburse Transporter for

filing fees upon receipt of an invoice therefore.

 

Shipper, by its signature, represents to Transporter that the information above is correct and

accurate.

 

By: ____________________________________________________

Signature

 

_____________________________________________________

Type Name and Title

 

Telephone Number: ________________________________

 

Facsimile Number: ________________________________