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:______________________________________
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
Type Name and Title
Telephone Number: ________________________________
Facsimile Number: ________________________________